City of Round Rock Supplemental Information Form

Description

SUPPLEMENT W-9 FORM CITY OF ROUND ROCK, TEXAS 221 EAST MAIN STREET, ROUND ROCK, TEXAS 78664 Pursuant to Internal Revenue Service Regulations (IRS), we ask that you furnish the City of Round Rock with your Taxpayer Identification Number (TIN). If this number is not provided, IRS regulations require us to subject you to a 28% withholding on each payment. To avoid this withholding and to ensure that accurate tax information is reported to the IRS, we would appreciate your cooperation in providing us with the information requested below. Thank you for your assistance in this matter. INDIVIDUAL: List name as shown on your social security card and your social security number. SOLE PROPRIETORSHIP/SINGLE MEMBER LLC: List the owner's legal name, followed by the legal business name, and list the owner's social security number/Employee Identification Number (EIN) ALL OTHERS: List the legal name of your corporation, partnership, organization, or other legal entity. IF INDIVIDUAL OR SOLE PROPRIETORSHIP NAME: (Last, First) LEGAL BUSINESS NAME: DOING BUSINESS AS (DBA): (if applicable) Main Mailing Address Remit Address: (if different than W9 Check for remit to address only. Mailing Address: Address: _____________________________________ City State Zip Code Check Payable to_________________________________ Address: _______________________________________ City: ________________________________________ Zip Code State _________ Business/Individual Email: Website address: BUSINESS ENTITY (please check only one): ☐ Individual ☐ Sole Proprietorship ☐ S-Corporation ☐ Limited Liability Company LLC (select tax classification below): ☐ C-Corporation ☐ Other ☐ Partnership ☐ Single Member LLC ☐ ☐ Trust/Estate S-Corporation ☐ ☐ ☐ C-Corporation ☐ D-Disregarded Entity/sole proprietorship P- Partnership Public Service Corporation ☐ Governmental ENTER THE NINE (9) DIGIT TAXPAYER IDENTIFICATION (TIN) BELOW: Social Security Number: (if applicable) Federal Employer Identification Number: (If applicable) ☐ Non-Profit CONTACT INFORMATION: Sales Contact Name: Title: Phone Number Fax Number Email Address Accounts Receivable Contact Name: Title: Phone Number Fax Number Email Address Contract Contact Name: Title: Phone Number Fax Number Email Address COMMODITY CODES: Please list any Commodity Codes that are associated your services/goods: UNDER PENALTIES OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, I DECLARE THAT THIS FORM HAS BEEN