Legal status Legal status I am a U.S. person

Legal Name of Taxpayer

Federal Tax Classification Federal Tax ClassificationIndividual/sole proprietor or single-member LLC selectedLimited liability company - C CorporationLimited liability company - S CorporationLimited liability company - PartnershipC CorporationS CorporationPartnershipTrust / Estate

Taxpayer Identification Number Type Taxpayer Identification Number Type Social Security Number (SSN) Employer Identification Number (EIN

SSN/EIN #

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