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Get Form W-9 (Rev. November 2005) (Fill-In Capable)

Ive form to the requester. Do not send to the IRS. Name (as shown on your income tax return) Business name, if different from above Check appropriate box: Individual/ Sole proprietor Corporation Partnership Other Exempt from backup withholding Address (number, street, and apt. or suite no.) Requester s name and address (optional) City, state, and ZIP code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.

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