W-9, Please fill out and email back to me. |
| 02-07 05:34:10 来源： 作者： |
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W-9, Please fill out and email back to me. Inquiry (采购产品): W-9, Please fill out and email back to me. REQUEST FOR SUPPLIER SET-UP INFORMATION AND TAXPAYER IDENTIFICATION NUMBER Please complete and mail to: Ameren Services, Accounts Payable m/c 230, PO Box 66892, St. Louis, MO 63166-6892 or fax it to: 314-554-3443 STEP 1. Supplier Set-Up Information Supplier Name: Address: City: State: ZIP: Primary Purchasing Contact: Name: Phone: Email: Primary Invoice Contact: Name: Phone: Email: Primary Product or Service provided to Ameren: NAICS Code: (See http://www.census.gov/naics) Business Classification (check the boxes as appropriate): ?? Minority Owned ?? Small Disadvantaged Business ?? Veteran Owned Small Business ?? Small Business ?? Historically Black Colleges and Universities ?? Service Disabled Veteran Owned Small Business ?? Woman Owned ?? Hubzone Small Business ?? Registration Number: ___________________ ?? None STEP 2. Taxpayer Classification and Identification Number (Check ONE box only and provide your complete name and Taxpayer Identification Number.) ?? U.S. Resident - Individual / Sole Proprietor (Form 1099 reportable) Name: If you are a sole proprietor, name of the owner of the business: Social Security Number __ __ __ ?a __ __ ?a __ __ __ __ or Employer Identification Number __ __ ?a __ __ __ __ __ __ __ ?? U.S. Partnership, Limited Liability Company (?°LLC?±), or Trust (Form 1099 reportable) Name (as shown on your tax return): Employer Identification Number __ __ ?a __ __ __ __ __ __ __ ?? U.S. Corporation (exempt from Form 1099 reporting except for medical or legal services) (If an LLC electing corporate status for U.S. tax purposes, please attach a copy of your U.S. tax election on IRS Form 8832, Entity Classification Election) Name (as shown on your tax return): Employer Identification Number __ __ ?a __ __ __ __ __ __ __ ?? U.S. Tax-Exempt Organization or Federal, State, or Local Government Agency (exempt from Form 1099 reporting) Name (as shown on your tax forms): Employer Identification Number __ __ ?a __ __ __ __ __ __ __ STEP 3. Certification/Signature Under penalties of perjury my signature certifies 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). 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. 3. I am a U.S. person (including a U.S. resident alien). Certification Instructions: You must cross out item 2 above if you have been notified by IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, number 2 above does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. Signature: Phone: ( ) Print Name: Title: Date: Email: Ameren Use Only Supplier Type:_________________________ Supplier No.: ___________ Entered by: _____________ Verification: ?? TIN Matching ?? Address/Phone Number ?? Other: ____________________ Date: __________________ **** Hidden Message ***** Jeff Landgraf 63166 Company: Ameren Corp. E-mail: jlandgraf@hotmail.com **** Hidden Message ***** jlandgraf@hotmail.com |
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