Affiliate W-9 Form | Maximum Impact Travel

Entity Information

1. Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.)

2. Business name/disregarded entity, if different from above

Note Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.

Exemptions

(codes apply only to certain entities, not individuals)

Exempt payee code (if any)

Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any)

Miscellaneous Information

Address

City, State and ZIP Code

List account number(s) here (optional)

Requester's name and address (optional)

Part I — Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your Social Security Number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your Employer Identification Number (EIN).

Social Security Number

OR

Employer Identification Number

Address

Requester's name and address (optional)

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).
I am not subject to backup withholding because:
- I am exempt from backup withholding; or
- I have not been notified by the IRS that I am subject to backup withholding due to failure to report all interest or dividends; or
- The IRS has notified me that I am no longer subject to backup withholding.
I am a U.S. citizen or other U.S. person (defined below).
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Cross Out Item 2

Certification Instructions

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.

Signature

Authorized Signature

Draw your signature here

Signature is required.

Date

W-9 Form

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