📄 W-9 Form

Request for Taxpayer Identification Number — Rev. March 2024

1. Name (as shown on your income tax return) *

2. Business name / disregarded entity name (if different)

3. Federal Tax Classification *

4. Exempt payee code

Exemption from FATCA code

5. Street Address (number, street, apt/suite) *

6. City, State, and ZIP Code *

7. Account number(s) (optional)

Part I — Taxpayer Identification Number (TIN)

Social Security Number (SSN)EIN

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Part II — Certification

Under penalties of perjury, I certify that: (1) The number shown on this form is my correct TIN; (2) I am not subject to backup withholding; (3) I am a U.S. citizen or other U.S. person; and (4) The FATCA code(s) entered on this form (if any) are correct.

Signature

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Date