CONTRACTOR APPLICATION FORM;
/
NAME:
FIRST
MIDDLE
LAST
DATE OF BIRTH
ADDRESS:
COMPANY NAME:
EIN or SOCLVL S E C U R I T Y #
C E L L PHONE #
EMAIL
ALTERNATE TELEPHONE #
DRIVER LICENCED
INSURANCE COMPANY INFO AUTO, BUSINESS, LIABILITY, THEFT, E C T
MAKE / MODEL OF WORK VEHICLE
YEAR
HAVE YOU E V E R BEEN CONVICTED OF A CRIME:
REFERANCES:
WHAT DO Y O U E X P E C T T O E A R N AS A STARTING H O U R L Y W A G E W I T H Y O U R
C U R R E N T Q U A L I F I C A T I O N S / S K I L L S AND T O O L S / E Q U I P M E N T T H A T Y O U W I L L
B E USLNG ON T H E JOB $
I C E R T I F Y THAT T H E INFORMATION IN THIS A P P L I C A T I O N IS C O R R E C T AND
G I V E PERMISSION F O R ANY R E F E R E N C E S T O B E C O N T A C T E D AND ANY
BACKGROUND C H E C K T O B E P R E F O R M E D .
SIGNATURE:
P L E A S E W R I T E ANY S K I L L S T H A T YOU H A V E T H A T MAY B E A P P L I C A B L E AND
R A T E Y O U R S K I L L IMVEh IN E A C H A R E A .
(NOVICE - APPRENTICE JOURNEYMAN-MASTER)
INCLUDE TOOLS, EQUIPMENT, WORK TRUCK, ECT...
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W-9
Request for Taxpayer
IdentMcatioii Number and Certification
Form
Pav.Decamt»r2014)
O a p s m w H o f lh« T r e a s w y
Interal Rawmue Sanice
Give FOTITI t o t h e
requester. D o n o t
sand t otheIRS.
1 N a n i a ( a B t i w w a n y D u r i n c a m e t a x r a t u m ) . hiamaiErsquii«dantha
2 S t n i n M S namc/diaregarciMJ entity n a m e , H diffarent f r o m
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3 C h a c k appropriate t w x for federal t a x classification; c h e d t only o n * o f t h e foVowing seven boxes:
Q
Ii
Q
mdh/ldual/sole proprietor o r
• C Corporatton
Q S Corporation •
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Q Tiust/estate
ainole-meinberac
L M t a d W i i i l y c t x n p a o y . Q r M r t f w t a x d a s s i f i c a l i o n ( C = C c o n a o r a t i o n , S s S c o r p o r o B o n , I ^ = p a r t n a r s f 4 > ) *•
N o w . F o r a i i n g i e - m e n i b ^ I X C t h a t i s d i s r e g a r d e d , d o n o t c h e d t L L C ; c h e d t ttie a p p r o p r i M b o x I n t h e l i n e a b o v e f o r
(he tax classificallon o f the singte-memtjer owner.
o t h e r ( s e e instnictton«)>S Addresa (number, street, a n d apt. o r suite no.)
A Exempttons (codes apply only t o
certain entitles, n o t indlwduate; s e a
tnatnidiana c n page 9 :
Exempt payee cod* | f a n ^
E M m f t f c n * o m F A T C A reporting
c o d e f f any)
Q
Requester's n a m e a n d address (optional)
6 City, stale, a n d Z P code
7 L i s t a c c o u n t n u m t i a r ( 4 h e r e (dpii«ta()
Taxpayer identification N u m b e r (TIN)
Enter your T I N i n t h e appropriate b o x . T h e T I N provided m u s t m a t c h t h en a m e given o nline 1t o avoid
bacl<up wHhholdffig. F o r individuals, this i s generafly your social security n u m b e r (SSN). However, f o ra
resident alien, sole proprietor, o rdisregarded entity, s e e t h ePart I instructions o n page 3 . For other
e n t i t i e s , i t i s y o u r e m p l o y e r i d e n t i f i c a t i o n n u m t M r ( E M ) . I f y o u d o n o t h a v e a n u m b e r , s e e How to get a
7?Afoitpage3.
iitty
or
N o t e . I f t h e a c c o u n t i s i n m o r e t h a n o n e n a m e , s e e * e i r t s t r u c t i o n s t o r l i n e 1 and t h e c h a r t o n p a g e 4 f o r
gutdstiryes o n w h o s e n u m b e r t o ertter.
P a r t II
U n d e r penalties o f periury. tcertify
tttat
1 . T h e n u m b e r s h o w n o n t h i s f o r m i s m y c o r r e c t t a x p a y e r i d e n t i f i c a t i o n n u m b e r (or 1 a m v r a i t i n g f o r a nuiTti>er t o b e I s s u e d t o rrte); a n d
2 . I a m n o t s u b j e c t t o b a c k u p w i t h h o l d i n g t>ecause: (a) I a m exerrq>t f r o m b a c l c u p vinttitiolding, o r (b) i h a v e n o t b e e n n o t i f i e d b y t h e i n t e r n a l R e v e n u e
S e r v i c e ( I R S ) t h a t I a m s u b j e c t t o b a c i u p w i t h h o k ^ a s a r e s u l t o f a f a i l u r e t o r e p o r t a l l i n t e r e s t o r d i v i d e n d s , o r ( c ) t h e ff^ h a s n o t i t i e d m e t h a t t a m
n o longer subject t o tiackup withhoidifig; arid
3 . I a m a U . S . c i t i z e n o r o t h e r U . S . p e r s o n ( d e f i n e d belov^O; a n d
4 . T h e F A T C A c o d e ( s ) e i r t e r e d o n tiiis f o r m (if a n ^ i n d i c a t i n g t h a t I a m e x e m p t f r o m F A T C A r e p o r t i n g i s c o r r e c t .
C a r t t t c a t i o n k w l n i c H o n a . Y o u m u s t c r o s s o u t i t e m 2 a b o v e if y o u Kiave b e e n n o t i f i e d b y t h e I R S t h a t y o u a r e c t w e n t l y s u b j e c t t o b a c k u p w i t h h o l d i n g
b e c a u s e y o u h a v e f a i l e d t o r e p o r t ai i n t e r e s t a n d d i v i d e n d s o n y o u r t a x r e t u r a F o r r e a l e s t a t e t r a n s a c t i o n s , i t e m Z d o e s n o t apfOf. F o r m o r t g a g e
J n t e r e s l fitid, a c q i f e l t l o n o r a t i a n d o n m e n t o f s e c u r e d p r o p e r t y , c a n c e l a t i o n o f d e t ^ , c o n t r i b u t i o n s t o a n I n d i v i d u a l r e t i r e m e r t t a r r a n g e m e n t ( R A ) , a n d
g e n e r a l l y , p a y m e r r t s o t h e r t h a n i r r t e r e s t a n d d i v W e n d s , y o u a r e n o t r e q u i r e d to s i y i t h e c e t ^ f i c a t i o n , b t r t y o u t m i s t p r o w d e y o u r c o r r e c t T i N . S e e t h e
irw>iv»cttor» o n p a g e 3 .
Here
G e n e r a l
Stgnatureor
U.S.peraea^'
Oel*»• F o r m 1098 (iiome m o r t g a s * interest), 108ft.E (student loan interest), l O e S - T
(tuition)
I n s t r u c t i o n s
Section references are t o the intsmai Revenue Code unless otherwise noted.
F u t u r e d e v e l a p m a n t a . W o m i a t i c n a t x x i t devefeipniants aflactlng F o r m W - 9 (such
a s l e g i s l a t i o n e n a c t e d a f t e r m r e l e a s a i f ) i s a t www.lrs.gav/fw9.
Purpose of Form
A n i n d i v i d u a l o r e n t i t y ( F o r m VI/-9 r e q t M S t e r ) w h o i s r e q u i r a d t o file a n i n f o r m a t i o n
r a t u m «<ith t h e I R S m u s t o b t a i n y o u r c o r t a c t t » p ^ « r i d e n t i f i c a t i o n n'jmbet (mf
w h i c h m a y tie your s o d a l security n u m i j e r (SSN), irxtvidual taxpayer I d e n t l f i c ^ o n
r x a n b a r QTIN), a d a p t i o n t a x p a y e r I d e n t l f l c t fI o n n u m b e r ( A T I N ) , o r e m p l o y e r
ider*«ea«ion n u m b e r < E I 4 t o r e p o r t o n a n W o i m a t l o n r e t u r n t h e a m o u n t p r f d t o
you, or other a m o u n t reportable o n a n Information r a t u m . Examples o f information
r e t u r n s i n c l u d e , b u t a r e n o t l i m i t e d t o , ttw t o l o w i n g :
• R x T n 1 0 9 B - t N T (trrterast e a r n e d o r p a i d )
• F o r m 1099-OIV (dtvidands, including t h o e e f r o m s t o c k s o r m u t u a l funds)
• F o r m 1 0 9 9 - M t S C (various types of income, prizes, awards, or
7 0 S S
proceeds)
• F o r m 1 0 9 9 - B ( s t o c l ( o r m u t u a l fiffsd s a l e s a n d caitalr, o t h e r t r a n e a c t i c R s b y
brokars)
• F o r m t 0 9 9 - S (procaads frtxn real estate transaction^
• F o r m 1 0 8 9 - C (carceied debt)
• F o r m t 0 d 9 - A (acquisilion or a b a n d o r m e n t o f s e a r e d property)
U s e F o m t W - 9 o n l y if y o u a r e a U a p e r s o n (includmg a raaidant d t a n ) , t o
p R n M e your conact TIN.
i f y o u do not return Form W-9 to the r e q u e s t e r with a VN, you migM b e subied
to b a c k u p withholding. S e e What is baclaii withholding? o n p a g e 2 .
B y signing t h e fiHed-out f o r m , y o u ;
1 . Certify t h a t t h e T I N y o u are giving ia c o n a c t (or y o u ara w a i t i n g f o r a n u m b e r
t o t M issued),
2. Certify that y o u a r e n o t subiect I 0 backup withholding, or
3. Q a i m exemption f r o m kiackup wittihahting if y o u a r e a U.S. e x e m p t payee. II
applicable, y o u a r e also certlfyino t h a t a s a U . a p e r s o n , y o u r aliocafate s h a r e o f
any partnership i n c o m * f r o m a U.S. trade or business is n o t sutiject t o t h a
withhoiding t a x o n foreign partners' siiara o f effectiveiy connected income, a n d
4 . C s f t J t y t h a t F A T C A codo<s) s n t a r o d ors t h i s t e r m p a n y ) ( n d i c a t i n g t h a t y s u a r e
e x e m p t from t h e F A T C A r s p o r t i n s , i s c o r r e c t S e e W h a t i s F A T C A r ^ p o r t i r i 0 7 o n
p a g e 2 for further infomiatian.
• F o r m 1090-K M e r c h a n t card a n d t t # d party natwoiic transactions)
cu.No. l o e a i x
F o m W - 0 (Pev. 12-2014)