Form
W-9
Rev. March 2024
Requested By Dealer Industries Automotive Supply
1
Name and Address
2
Tax Information
3
Certification
4
Review and Submit
Name and Address
Name as shown on tax return
Enter the name of the individual, sole proprietor, partnership, or other entity as it is shown on your income tax return.
Business or disregarded entity name
(optional)
If you have a business name, trade name, DBA name, or disregarded entity name that is different from the name above, enter it here.
Are you in the United States?
Yes
No
Street address
Do not include city or state in this field.
City
State
Select one
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Zip code
Enter your 5 or 9 digit zip code.
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