W-9 Form

W-9

Request for Taxpayer Identification Number and Certification

As a cooperative member-owner, a W-9 is required to pay out Capital Credits. If a joint account, both members must complete a W-9.

Name *(as shown on your income tax return)

Business Name(if different from above)

Check the appropriate box for federal tax classification of the person whose name is entered. *Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited Liability CompanyOtherCheck only one of the following seven boxes

Enter the tax classification(C=C corporation, S=S corporation, P=Partnership)

Other(see instructions)

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3)

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Taxpayer Indentification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Social Security Number or Employer Identification Number *Social Security NumberEmployer Identification NumberCheck which applies to you.

Social Security Number *0 / 11

Employer Identification Number *0 / 10

Certification

Under penalties of perjury, I certify that:
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 (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of U.S. person *By entering your name on the line, you are effectively providing your signature.

Date *

Joint Account? *YesNoIf a joint account, both members must complete a W-9.

Joint Account - W-9

Request for Taxpayer Identification Number and Certification

Joint Account Name *(as shown on your income tax return)

Joint Account - Business Name(if different from above)

Joint Account - Check the appropriate box for federal tax classification of the person whose name is entered. *Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited Liability CompanyOtherCheck only one of the following seven boxes

Joint Account - Enter the tax classification(C=C corporation, S=S corporation, P=Partnership)

Joint Account - Other(see instructions)

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Joint Account - Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3)

Joint Account - Exempt payee code (if any)

Joint Account - Exemption from FATCA reporting code (if any)

Joint Account - Taxpayer Indentification Number (TIN)

Joint Account - Social Security Number or Employer Identification Number *Social Security NumberEmployer Identification NumberCheck which applies to you.

Joint Account - Social Security Number *0 / 11

Joint Account - Employer Identification Number *0 / 10

Joint Account - Certification

Joint Account - Sign Here

Joint Account - Signature of U.S. person *By entering your name on the line, you are effectively providing your signature.

Joint Account - Date *

Email Address *Provide email address for form submission confirmation.

Already have a completed paper version W-9? Skip completing the online form above and upload your completed version here:

W-9 Form

W-9

Request for Taxpayer Identification Number and Certification

Joint Account - W-9

Request for Taxpayer Identification Number and Certification

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