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Taxpayer Information

Tax Year

Employer Identification Number

Name (not your trade name)

Trade Name (if any)

Country

Foreign Province, State, County Foreign Province, State, County is required

Foreign Postal Code Foreign Postal Code is required

Part 1: Answer these questions for this year.

Employers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico can skip lines 1 and 2, unless you have employees who are subject to U.S. income tax withholding.

Line 1: Wages, tips, and other compensation

Line 2: Federal income tax withheld from wages, tips, and other compensation.

Line 3: Check this box if there are no wages, tips, and other compensation subject to social security or Medicare tax.

Part 2: Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank.

Line 3: Total payments to all employees

Line 4: Payments exempt from FUTA tax

Check all that apply

4a. Fringe Benefits

4b. Group-term life insurance

4c. Retirement/Pension

4d. Dependent Care

4e. Other

Line 5: Total of payments made to each employee in excess of $7,000

Part 3: Determine your adjustments. If any line does NOT apply, leave it blank.

Line 10: FUTA Adjustment. Enter the amount from Line 7 of the Form 940 Instructions Worksheet

Line 11: If credit reduction applies, enter the total from Schedule A (Form 940)

Part 4: Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank.

Line 13: FUTA tax deposited for the year, including any overpayment applied from a prior year

Part 5: Report your FUTA tax liability

16. Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for a quarter, leave the line blank. 16a - 1st quarter (January 1 – March 31)

16b - 2nd quarter (April 1 – June 30)

16c - 3rd quarter (July 1 – September 30)

16d - 4th quarter (October 1 – December 31)

Part 6: May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS?

Yes

Designee Full Name

Phone Number

Select a 5-digit personal identification number (PIN) to use when talking to the IRS

Part 7: Sign here. You MUST complete both pages of this form and SIGN it.

Signature

Use your cursor to sign your name above

Date

Print your name here

Print your title here:

Best daytime phone

Are you a paid preparer?

Yes

Preparer's Full Name

Preparer's Signature

Use your cursor to sign your name above

Date

PTIN

Check if self-employed

Firm’s name (or yours if self-employed)

Country

Firm's Address (Street and Number)

Apt/Ste No.

City

State

Zip Code

Firm's EIN

Firm's Phone

Applicant's Mailing Address

Country

Mailing Address (non-US)

Address (Number and Street)

Birth Information

Birth Date

Identification Document(s) Submitted

Passport

Driver's License / State ID

USCIS Documentation

Other

Tax and Employee Number Information

Sign here :

Under penalties of perjury, I (applicant/delegate/acceptance agent) declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I authorize the IRS to share information with my acceptance agent in order to perfect this Form W-7, Application for IRS Individual Taxpayer Identification Number.

Delegate's Relationship to Applicant

Parent

Court-appointed Guardian

Power of Attorney

Email Information

Insert the e-mail address to which you want to receive your W9 form.

Your Email Address

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