This form contains 23 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
7 List account number(s) here (optional) Text
Optionally, list any account numbers associated with your tax records.
Entity Type
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[0]_1 CheckBox
Check this box if you are an individual/sole proprietor or single-member LLC.
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[1]_2 CheckBox
Check this box if you are a C Corporation.
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[2]_3 CheckBox
Check this box if you are an S Corporation.
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[3]_4 CheckBox
Check this box if you are a Partnership.
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[4]_5 CheckBox
Check this box if you are a Trust/Estate.
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[5]_6 CheckBox
Check this box if you are a Limited Liability Company (LLC).
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_1[6]_7 CheckBox
Check this box if you are an Exempt Payee.
Exemption
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].c1_2[0]_1 CheckBox
Check this box if you are exempt from backup withholding. Refer to the form instructions to determine if you qualify for exemption.
Exempt payee code (if any) Text
Enter the exempt payee code if you are exempt from backup withholding. Refer to the form instructions for the list of codes.
Identification 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.) Text
Enter the full name of the individual or entity. For sole proprietors or disregarded entities, enter the owner's name here.
2 Business name/disregarded entity name, if different from above Text
Enter the business name or disregarded entity name if it is different from the name entered in the previous field.
Personal Information
topmostSubform[0].Page1[0].f1_06[0 Text
Enter your full name as shown on your tax return.
5 Address (number, street, and apt. or suite no.). See instructions Text
Enter your address, including number, street, and apartment or suite number. Refer to the form instructions for more details.
6 City, state, and ZIP code Text
Enter your city, state, and ZIP code.
Requester Information
Requester's name and address (optional) Text
Optionally, enter the name and address of the requester.
Tax Identification Number
Social security number Text
Enter your Social Security Number (SSN).
Max length: 1 characters
topmostSubform[0].Page1[0].Boxes3a-b_ReadOrder[0].f1_04[0 Text
Enter your Employer Identification Number (EIN) if applicable.
topmostSubform[0].Page1[0].f1_11[0 Text
Enter the first part of your Social Security Number (SSN).
Max length: 3 characters
topmostSubform[0].Page1[0].f1_12[0 Text
Enter the second part of your Social Security Number (SSN).
Max length: 2 characters
topmostSubform[0].Page1[0].f1_13[0 Text
Enter the third part of your Social Security Number (SSN).
Max length: 4 characters
Employer identification number Text
Enter the first part of your Employer Identification Number (EIN).
Max length: 2 characters
Employer identification number Text
Enter the second part of your Employer Identification Number (EIN).
Max length: 7 characters