Substitute W-9 : Taxpayer Identification Number Request
Please complete the following information. We are required by law to obtain this information from you when making a reportable payment to you. Section 3406 of
the Internal Revenue Code requires that we withhold a predetermined percent in tax (28%), called backup withholding, when you do not give us your correct Name/Tin
combination. Payments that are subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay,
and certain other payments. Real estate transactions are not subject to backup withholding.
If you fail to furnish your correct TIN, you may be subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful
neglect.
Your TIN is required whether or not you are required to file a tax return.
Use this form only if you are a U.S. person (including U.S. resident alien). If you are a foreign person, use the appropriate Form W-8.
Part 1 – Tax Status
Complete only one of the sections below.
Individual’s Name (Last, first, middle)
Individual
- OR -
Individual’s Social Security Number
A dba (doing business as) may be used in the Business or Trade Name, but should NOT be in Owner’s Name.
Owner’s Name (Last, first, middle)
-EITHER- Owner’s Social Security Number
Sole Proprietor (also, LLC
Business or Trade Name
-OR- Federal Employer ID Number
Partnership (also, LLP, LLC
Partnership’s or Entities Legal Name on IRS Records (see IRS Mailing Label)
Federal Employer ID Number
with multiple owners,
other non-exempt
companies and entities)
Business or Trade Name (if different from Legal Name)
with single owner)
- OR -
- OR -
□
Exempt Entities
[C/S Corporation, Government…]
*a box must be checked to be
classified as exempt
Corporation ,
Subchapter C or S
–or– LLC granted
corporation status
(No Exemption for
medical, healthcare and
legal service payments)
□
Tax
Exempt
Entity
under
501(a),
501(c)(3)
or IRA
□
The United
States or
any of its
agencies or
instrumentali
ties
Legal Name of Corporation or Entity (see Articles of Incorporation)
A state, the District of
a possession □
□ ofColumbia,
the United States, or
any of their political
subdivisions or
agencies
A foreign government or
any of its political
subdivisions or an
international organization in
which the United States
participates under a treaty
or Act of Congress
Federal Employer ID Number
Business or Trade Name (if different from Legal Name)
Part 2 – Address
Tax Correspondence Address
Part 3 - Certification
Under penalties of perjury, I certify that:
1. 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
2. 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
3. I am a U.S. person (including a U.S. resident alien).
Print Name
Phone
Sign Signature of US Person
Here ►
Date
Return Certified Forms to:
Fax: (803)777-2032
Mail: University of South Carolina
Purchasing
1600 Hampton St.
Columbia, SC 29208
UNIVERSITY OF SOUTH CAROLINA CONTROLLER’S OFFICE COLUMBIA, SOUTH CAROLINA 29208 803/777-2602 FAX 803/777-9586