Request for Taxpayer 
Identification Number and Certification

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

2. Business name/disregarded entity name, if different from above


3. Check appropriate box for federal tax classification of the person whose name is entered on line 1.

4. Exemptions (codes apply only to certain entities, not individuals):

Exempt payee code (if any)  

Exemption from FATCA reporting code (if any)  

(Applies to accounts maintained outside the U.S.)


5. Address (number, street, and apt. or suite no.)

6. City, state, and ZIP code

7. List account number(s) here (optional)

8. Provide Your EIN or SSN

Leave this empty:

Signature arrow sign here

Signature Certificate
Document name: Tax W-9 Form
lock iconUnique Document ID: 840d82764bc7f1d1de2895e75b31c70bb7ee3ef3
Timestamp Audit
January 4, 2022 4:29 pm EDTTax W-9 Form Uploaded by Mermaid Swim School - IP
January 13, 2022 4:55 pm EDT Document owner has handed over this document to 2022-01-13 16:55:47 -