Please complete the information below so we know how to pay you.

Your name

Your email

Your company

Your company address

City

State

Zip code

Your Federal tax ID number or Social Security Number

Check the appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or single-member LLCC-CorpS-CorpPartnershipTrust/estateLimited liability company
Limited liability company tax classification (if applicable) C= C corporation, S= S corporation, P= Partnerships

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Name on Bank Account (This is the company name, or your name, that appears on the bank account. This is not the bank’s name).

Your bank’s routing number

Your account number

Any message you’d like to send us (optional)