Substitute W-9 Form

Request for Taxpayer Identification Number

We are required to file an information return (a 1099) with the Internal Revenue Service relating to a Payment(s) made to you as an independent contractor or freelancer for tax purposes in the United States. In order to do so, we are required to obtain your correct taxpayer identification Number (TIN). This Substitute W-9 is a quick and secure way to provide us with the minimum amount of information that we need to file with the Internal Revenue Service.

If you prefer to fax us your W9, please download the IRS W9 form and fax to +1 215 821 8991.

Email Address

TIN Owner Name

TIN Type

SSN

EIN

Tax Identification Number (TIN) pertaining to the above name is:

Business Name

Address

Under penalties of perjury, I certify that:

The number shown on this form is my correct Tax Payer identification number, and
I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. citizen or U.S. resident alien.

Name:

I certify