Part 1 Tax Status:(Choose one status and complete the associated boxes)
Individual/Sole Proprietor:
A sole proprietorship may have a trade name (doing business as), but the legal name is the name of the business owner.
Business or Trade Name:
Business Owner's Name: (if different)
Business Owner's Employer Identification Number:
-
Do not use your social security number.
Partnership: A Partnership may have a trade name (doing business as), but the legal name is the list of the names of the partners.
Name of Partnership:
Partnership's Employer Identification Number:
-
Partnership's Legal Name (Name of First Partner):
Limited Liability Company (LLC)
Name of LLC:
Employer Identification Number:
-
Corporation, exempt charity, or other entity: A corporation
may use an abbreviated name, but the legal name is the name on the articles of incorporation.
Name of Corporation or Entity:
Employer Identification Number:
-
Are you exempt from Form 1099 reporting?
Yes
No (Legal or Medical company)
If you are exempt from Form 1099 reporting, please choose one:
Part 2 Certification: I certify under penalty of perjury that the Tax Identification Number I have provided is correct. I am a U.S. person (including a U.S. resident alien).