General Information

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Please enter a valid email address.
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Address

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Tax Information

Individual Business
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You acknowledge and agree that your electronic signature will have the same legal force and effect as an original manual signature.

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), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. citizen or other U.S. person

I consent to receiving my 1099 form electronically at the email address I have provided. If I leave this field blank, a paper copy will be mailed to me.