Carrier Information

Collect a carrier's tax and identification information, including federal classification, address, and identification number.

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Form Instructions

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Name (as shown on your income tax return)

Business Name / Disregarded Entity Name (if different from above)

Federal Tax Classification: Individual/Sole Proprietor

Individual/sole proprietor or single-member LLC

Other Federal Tax Classification (specify)

Exempt Payee Code (if any)

Federal Tax Classification: Limited Liability Company

Limited liability company (LLC)

LLC Tax Classification Code (C, S, or P)

FATCA Exemption Code (if any)

Street Address (Number, Street, Apt. or Suite No.)

City, State, and ZIP Code

Requester's Name and Address (optional)

Social Security Number – First 3 Digits

Social Security Number – Middle 2 Digits

Social Security Number – Last 4 Digits

Employer Identification Number – First Part

Employer Identification Number – Second Part

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