W-9 - WYO HELP

Your taxpayer identification number is sensitive information.

Your Social Security Number or Employer Identification Number is used to create the completed W-9 record. It is not included in the notification email or the WYO HELP tracking log.

Before you begin:

Use this form only when WYO HELP or one of the organizations listed below has requested a W-9 from you. Submission of a W-9 does not authorize or guarantee payment.

Who Requested This W-9?

Select the organization that asked you to complete this form. Your completed W-9 will be stored in that program's restricted W-9 folder.

Requesting Organization *

Taxpayer Information

1. Name *

Enter the name shown on your federal income tax return.

2. Business name / disregarded entity name

Complete only if different from the name entered above.

3a. Federal tax classification *

Individual / sole proprietor C corporation S corporation Partnership Trust / estate Limited liability company (LLC) Other

LLC federal tax classification *

Describe other federal tax classification *

3b. Foreign partners, owners, or beneficiaries

This generally applies to certain partnerships, trusts, estates, and other flow-through entities with foreign partners, owners, or beneficiaries.

4. Exempt payee code

Usually leave blank. Complete this only if you know that you qualify as an exempt payee and know the applicable IRS exemption code.

FATCA exemption code

Usually leave blank. Most individuals and ordinary U.S. businesses will not need this field. Complete it only if you know that a FATCA exemption code applies to you.

5. Address *

6. City *

State *

ZIP code *

Part I — Taxpayer Identification Number

Enter either your Social Security Number or Employer Identification Number, as appropriate for the name entered above.

Type of taxpayer identification number

Social Security Number (SSN) Employer Identification Number (EIN)

SSN or EIN

Enter 9 digits. Formatting characters are optional.

I have applied for a taxpayer identification number and am waiting for it to be issued.

Contact Information

Email *

Phone

Part II — Certification

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number, or I am waiting for a number to be issued to me;
The backup withholding statement selected below is correct;
I am a U.S. citizen or other U.S. person; and
Any FATCA exemption code entered on this form is correct.

Backup Withholding

I am not subject to backup withholding. I am exempt, have not been notified by the IRS that I am subject to backup withholding for failure to report interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding. I am currently subject to backup withholding. The IRS has notified me that I am subject to backup withholding because I failed to report all interest or dividends on my tax return.

I certify under penalties of perjury that the information and certifications above are true and correct. I am the person identified on this W-9 or I am authorized to sign this W-9 for the person or entity identified above.

Electronic Signature

Sign below using your mouse, touchscreen, stylus, or finger. Your electronic signature will be placed on the completed W-9 record.

Printed Name *

Title / Capacity

Date *

Signature *

Your completed W-9 is stored in the restricted folder designated for the organization requesting this form. Taxpayer identification numbers are not included in notification emails.