EMBARCADERO TECHNOLOGIES, INC. TAXPAYER IDENTIFICATION REQUEST

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Page 1 of 2 EMBARCADERO TECHNOLOGIES, INC. TAXPAYER IDENTIFICATION REQUEST Dear Vendor: Your United States TAXPAYER IDENTIFICATION NUMBER MUST be provided regardless of your tax status. We are required by law to obtain a tax identification number when making a reportable payment to you. Failure to provide this information could result in a tax withholding of up to 30%, applicable state withholding and penalties. Please complete this substitute W9 form and return via fax or mail to the above location. Please be advised that failure to respond may cause a delay in the processing of your payments. Substitute W9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION Return this form to the requester. Do NOT send to the IRS. Taxpayer’s Name (If joint names, list first and circle the name of the person or entity whose number you enter in Part I below). Business Name PART I Please check appropriate box and enter your Taxpayer Identification Number (TIN) below on the appropriate line. For individuals, this is your social security number (SSN). For other entities, it is your employer identification number (EIN). Individual/Sole Proprietor Corporation Partnership/LLC/LLP Other ___________________________ I am a resident of, have a permanent place of business in or am subject to the laws of California at the address shown below and will file a California return. I will promptly notify you if my status changes. YES NO IF YOU CHECKED INDIVIDUAL/SOLE PROPRIETOR, ENTER INDIVIDUAL'S NAME AND SOCIAL SECURITY NUMBER ______________________________________________________________________________SSN: __ __ __ - __ __ - __ __ __ __ IF YOU CHECKED OTHER THAN INDIVIDUAL/SOLE PROPRIETOR, ENTER APPLICABLE FEDERAL TAXPAYER IDENTIFICATION NUMBER AND CALIFORNIA CORPORATION NUMBER (IF APPLICABLE) ______________________________________________________________________________TIN: __ __ - __ __ __ __ __ __ __ Address (number, street, and apt. or suite no.) TAXPAYER’S PHONE NUMBER City, State and ZIP Code TAXPAYER’S FAX NUMBER In order to make this form complete and enable us to make payment to you, please answer Part II on page 2, print your name, sign and date. Embarcadero Technologies, Inc. 100 California Street, 12th Floor San Francisco, CA 95066 USA Developer Relations Fax: 1-831-431-5119

Transcript of EMBARCADERO TECHNOLOGIES, INC. TAXPAYER IDENTIFICATION REQUEST

Page 1: EMBARCADERO TECHNOLOGIES, INC. TAXPAYER IDENTIFICATION REQUEST

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EMBARCADERO TECHNOLOGIES, INC.TAXPAYER IDENTIFICATION REQUEST

Dear Vendor:

Your United States TAXPAYER IDENTIFICATION NUMBER MUST be providetax status. We are required by law to obtain a tax identification number when mpayment to you. Failure to provide this information could result in a tax withhoapplicable state withholding and penalties. Please complete this substitute W9 formor mail to the above location.

Please be advised that failure to respond may cause a delay in the processing of

Substitute W9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION

Taxpayer’s Name (If joint names, list first and circle the name of the person or entity whose number you

Business Name

PART I

Please check appropriate box and enter your Taxpayer Identification Number (TIN) beline. For individuals, this is your social security number (SSN). For other entities, it identification number (EIN).

Individual/Sole Proprietor Corporation Partnership/LLC/LLP Other __________

I am a resident of, have a permanent place of business in or am subject to the laws of California at the adCalifornia return. I will promptly notify you if my status changes. YES NO

IF YOU CHECKED INDIVIDUAL/SOLE PROPRIETOR, ENTER INDIVIDUAL'S NAME AND SOCIAL SECURIT

______________________________________________________________________________SSN: __ __

IF YOU CHECKED OTHER THAN INDIVIDUAL/SOLE PROPRIETOR, ENTER APPLICABLE FEDERAL TAXPAAND CALIFORNIA CORPORATION NUMBER (IF APPLICABLE)

______________________________________________________________________________TIN: __ _ Address (number, street, and apt. or suite no.) TAX

City, State and ZIP Code TAX

In order to make this form complete and enablto make payment to you, please answer Part IIon page 2, print your name, sign and date.

Embarcadero Technologies, Inc.100 California Street, 12th FloorSan Francisco, CA 95066 USADeveloper RelationsFax: 1-831-431-5119

d regardless of youraking a reportable

lding of up to 30%, and return via fax

your payments.

Return this form to therequester. Do NOTsend to the IRS.

enter in Part I below).

low on the appropriateis your employer

_________________

dress shown below and will file a

Y NUMBER

__ - __ __ - __ __ __ __

YER IDENTIFICATION NUMBER

_ - __ __ __ __ __ __ __

PAYER’S PHONE NUMBER

PAYER’S FAX NUMBER

e us

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PART II

Business Size/Classification:

Borland Software Corporation supports and participates in the Government’s small and disadvantaged businessprograms. Our participation requires written representation from our supplier’s and contractors as to theirbusiness status according to the following:

A. Small Business Enterprise – An enterprise independently owned and operated with 500 or fewer employees.

B. Small Disadvantaged Business – An enterprise meeting the criteria that is at least 51% owned and controlled by socially and economically disadvantaged group members. Socially and economically disadvantaged in defined to include Black Americans, Hispanic Americans, Native Americans and Asian-Pacific Americans.

C. Women Owned Small Business – An enterprise at least 51% owned and controlled by women members regardless of their ethnic background.

D. Historically Black Colleges and Universities and Minority Institutions.

E. Hubzone Small Business.

F. Veteran-Owned Small Business (self-certified): Is a small business; and is at least 51% owned, controlled and active involvement in day-to-day operations by one or more veterans.

G. Service Disabled Veteran Owned Small Business: Is a veteran with a disability that is service-connected.

H. None of the above apply

Under penalties of perjury, I certify that the number shown on this form is my correct TIN and that all other requested information is correct, that I am a U.S. person, and that I am not subject to backup withholding because (1) I am exempt from withholding or (2) I have not been notified by a tax agency, including the Internal Revenue Service that I am subject to backup withholding.

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