Name (as shown on your Tax Return):
Business Name:
Business Type:
Examples of exempt payees include 501(c)(3), organizations, states, and certain trusts.
If the company is a limited liability company, the publisher must specify whether the limited liability company is taxed as a C corporation, S corporation, partnership, or disregarded entity. If the limited liability company is taxed as a disregarded entity and the individual publisher is the sole owner, then the publisher must provide his social security number as the tax identification number, not an employer identification number.
Tax Numbers:
Contact Information:
Verify and Confirm:
In addition to providing the information above, the publisher must certify under penalty of perjury that the publisher is a U.S. citizen or other U.S. person, and that the taxpayer identification number provided is correct.
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