Form Page: SelfServe

Name (as shown on your Tax Return):

Business Name:

Business Type, Check One:

Individual

Business

Tax Numbers:

TIN:

Contact Information:

Mailing Address:

State/Province:

Country:

Postal Code:

City:

Phone:

Email Address:

Verify and Confirm:

In addition to providing the information above, the publisher must certify under penalty of perjury that the publisher is not a U.S. Citizen, and that the taxpayer identification number provided is correct (if applicable).

I verify that the information I am submitting is correct and that I am an publisher foreign to the U.S. who is submitting W8 Form located here. U.S. Citizens, please click here.

I Agree to the

Terms and Conditions

Signature (you must type your full name below):

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