IRS W9 Form

Option 1) Complete form, Print, and mail to:

Government Solutions Team @ 523 Carver Lane, Lebanon, TN 37087

Option 2) Complete form, Print, Scan, then attach to email:

Option 3) Complete the fillable form below and send by clicking “Submit”.

Name (as shown on your income tax return)	:
Business name/disregarded entity name, if diff. from above	:

Check appropriate box for federal tax classification :

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Limited liability company: Tax Classification- C corporation Limited liability company: Tax Classification- S corporation Limited liability company: Tax Classification- P partnership Other

If other:

Address (number, street, and apt. or suit no.)	:
City, State, and ZIP code	:

Part 1. Taxpayer Identification Number (TIN)

SSN

Employer ID Number

Part 2. Certification

Under penalties of perjury, I certify:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that 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

3. I am a U.S. citizen or other U.S. person, and

4. Provide your signature, certifying the above information is correct.

Initials of U.S. person	:
Email (required for submission purposes)	:

***If you choose option 1 or 2, please disregard the submission and click here for Equipment, or click here for Power.***

IRS W9 Form

Part 1. Taxpayer Identification Number (TIN)

Part 2. Certification

Contact Greg Haglin

Contact Roseanne Haglin