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Phone Number List account number(s) here Sign Signature of U.S. person Date 2396562300 8005992356 fax 2399954287 PLEASE COMPLETE, SIGN, AND RETURN W9 FORM FAILURE TO RETURN THIS FORM COULD RESULT

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Please complete sign and is a form that requires completion and a signature.

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Individuals or entities specified by the organization.

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Please follow the instructions on the form and provide all necessary information.

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The purpose is to ensure completion of required information and authorization by the designated individual.

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Information requested on the form such as name, date, signature, etc.

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