W-9 Form Electronic Submission 2017 W-9 Online 2017 W-9 Online Electronic W-9 Form - An email with your W-9 as a PDF secured by the last 4 digits of your TIN will be sent immediately after submission. Please enter all information for the W-9 form exactly the same as the name already on file with PHBA for that entity and same TIN. PHBA Online 2017 Annual $65.00 Dues Payment. PHBA annual dues require an updated W-9 to be completed prior to accepting your dues payment. After completing the HTTPS secured W-9 submission, you will be redirected to the PayPal secure portal site to enter your payment information. (Your submitted W-9 form is protected with the last 4 digits of your tax information number and will be emailed to you upon completion and a separate payment confirmation will be emailed from PayPal.)PHBA 2017 Annual Dues Price: $65.00 Email* Enter Email Confirm Email Email address for W-9 Form filled online to be sentRequest for Taxpayer Identification and CertificationName (as shown on your tax return and TJC breeder registration)*Business Name, if different from aboveNot required - use for Farm Name, DBA name or leave blankCheck appropriate box*Individual / Sole Proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/EstateLimited Liability CorporationOtherLimited Liability Company - tax classification:*C = C CorporationS = S CorporationP = PartnershipIf Other indicate type of Entity*Address (number, street, and apt. or suite no.)* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Telephone*(999) 555-1212 10 digit phone number with area code.Cell Phone(999) 555-1212 10 digit phone number with area code.FAX(999) 555-1212 10 digit phone number with area code.Social Security Number*Taxpayer SSN for Individual / Sole ProprietorEmployer Identification Number*Federal Tax ID Number Digital Signature RequiredName*Name of individual or name of business ownerBy Clicking "I Agree" button below and filling in the below Captcha, you acknowledge that you are electronically submitting this W-9 form and agree to the terms immediately below.* I Agree Submission of this W-9 form electronically requires the use of a digital signature. The Pennsylvania Electronic Submission Act, 73 P.S. § 2260.101, authorizes the Pennsylvania Department of Agriculture to accept digital signatures in place of manual signatures. Your electronic submission of this form has the same legal effect as your manual signature.CommentsThis field is for validation purposes and should be left unchanged.