Form Bfm-0001 - Substitute W-9 Taxpayer Identification Number (Tin) Verification - 2013 Page 2
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4Substitute W-9 Form, page 2
BFM-0001 (09/2013)
Instructions for Completing Taxpayer Identification Number (TIN) Verification
Legal Name
(as shown on your income tax form)
Individuals: Enter Last Name, First Name MI
Sole Proprietorships: Enter Last Name, First Name MI
All Others: Enter Legal Name of Business
Business Name
Individuals & Others: Complete if using a doing business as (DBA) name
Sole Proprietorships: Enter Business Name
Order-From Address
Address where orders should be sent.
Remit-To Address
Address where payments should be sent.
Entity Designation
Check ONE box which describes the type of business entity.
Taxpayer Identification Number (TIN)
LIST ONLY ONE: Social Security Number (SSN), or
Employer Identification Number (EIN), or
Individual Taxpayer Identification Number (ITIN).
If you do not have a TIN, apply for one immediately. Individuals use federal
form SS-5
which can be obtained from
the Social Security Administration. Businesses and all other entities use federal
form SS-4
which can be obtained
from the Internal Revenue Service.
Certification
You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. 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 arrangement (IRA), and generally, payments other than
interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN.
Privacy Act Notice
Section 6109
requires you to furnish your correct TIN to persons who must file information returns with the IRS to
report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or
abandonment of secured property, or contributions you made to an IRA, Archer MSA, or HSA. The IRS uses the
numbers for identification purposes and to help verify the accuracy of your tax return. You must provide your TIN
whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend,
and certain other payments to a payee who does not furnish a TIN to a payer. Certain penalties may also apply for
providing false or fraudulent information.
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