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Request for Taxpayer Identification Number and Certification

Name (as shown on your income tax return):
Business Name (if different from above):
Federal Tax Classification:
Individual/Sole Proprietor
C Corporation
S Corporation
Partnership
Trust/Estate
Limited Liability Company
Other
Address (number, street, and apt/suite no.):
Requester's Name and Address (optional):
City:
State:
ZIP Code:
List account number(s) here (optional):

Part 1

Taxpayer Identification Number (TIN)

Enter you your TIN in the appropri rlato box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For Individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For ather entities, it is your employer identification number (EIN), If you do not have a number, sse How to get a TiN on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social Security Number:
Employer Identification Number:

Part 2

Certification

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number for I am waiting for a number to be issued to me, and
2. I am not subject to backup withholding because: Det an exempt from backup withholding, or thi I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a fallure to report all interest or dividends, or ( 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).

Certification instructions. You must cross out item 2 above you have been notified by the IRS that you are currently subject to backup withholding because you have falled to report all interest and dividends on your tax ritum. 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 amangement (RA), and not required to sign the certification, but must provide your correct TIN. See the generally, paynnents other than interest and dividends, you Instructions on page 4

Date:

General Instructions

Section references are to the Internal Revenue Code unless otherwise noted.

Purpose of Form

A person who is required to file an information rstum with the IRS must obtain your comict taxpayer identification number (TIN) to report, for exampl Income paid to you you, mal estate transactions, morto ace Interest mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

of debt, or contributions you made to an IRA. Use Form W- only if you are a U.S. person including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2. Certify that you are not subject to backup withholding or
3. Claim exemption from backup withholding If you are a US. exempt payee. If applicable, you are also certifying that as a US. person, your allbcable shans of any partnership income from a US. trade or business is not subject to the withholding tax on foreign partners share of effectively connected incorne

Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's fonn if it is substantially similar to this Form W-8

Definition of a US. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7)

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases whens a Form W-9 nas not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your shars of partnership income.

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Independent Contractor Information

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