IRS Form W-9

Please complete all three forms:

IRS Form W-9
Confidential Credit Application
Authorization Agreement Direct Payments (ACH Debits)

Request For Taxpayer Identification Number & Certification
1. Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.*
First Middle Last
2. Business name/disregarded entity name, if different from above.*
3. Select appropriate federal tax classification of the person whose name is entered on line 1. Select one of the following nine boxes.*
5. Address*
Street Address Address Line 2 6. City State ZIP Code
7. List Account Number(s) here, optional
Part 1: Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also, see What Name and Number To Give the Requester for guidelines on whose number to enter.
Social Security Number
Or
Employer Identification Number
Part 2: Certification
Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Email of Signatory*
Enter Email Confirm Email
Uniform Electronic Transactions (UETA) Compliance
Consent to Electronic*
I am consenting to complete and receive, by electronic means, including through the email address provided above, communications regarding my application, including notice of your decision on my application as well as important account opening information regarding rates, fees, and other costs related to the account for which I am applying. I understand that these electronic disclosures may not be available in any paper or non-electronic form, so if I would like to retain a copy for my records, I may print or download these disclosures during this application process. I understand that to access and retain these electronic disclosures I must have or have access to the following hardware and software: (1) a computer or mobile device with Internet or mobile connectivity and an operating system; (2) an Internet browser that supports HTML 4.0, SSL encryption and JavaScript (e.g., the latest version of Internet Explorer, Firefox, Chrome or Safari); (3) software capable of opening documents in PDF format; (4) access to the email address I provided above; and (5) sufficient storage space to save Communications or a printer to print them. I understand that I must consent to receive these materials electronically to submit this application.
Consent to Electronic
Acknowledgement*
Shepherd Oil Company will begin processing this application as soon as it is received and will hold all information in strict confidence. TO EXPEDITE, PLEASE MAKE SURE THE ENTIRE APPLICATION IS COMPLETE AND SIGNED BY AN AUTHORIZED SIGNATORY OF THE BUSINESS. I, the undersigned, certify that I am an authorized Signature of the applicant, and can disclose information on behalf of the applicant and that all the information provided is true and correct. I hereby authorize Shepherd Oil Company or any agency or credit bureau employed by them, to investigate any references or other data obtained from me or from any other source. I authorize the references listed to provide any information requested by Shepherd Oil Company. I understand and agree that the applicant shall adhere to Shepherd Oil Company’s set terms and credit limits and that payment in full is due within the terms granted by Shepherd Oil Company. Any invoice not paid within the terms set by Shepherd Oil Company will be subject to a late fee of 1% on all overdue balances. Furthermore, I understand and agree that in the event Shepherd Oil Company, by reason of the account's delinquency and/or any reasonable reason, place the account with a collection agency or with an attorney, I will pay all costs, collection fees, and attorney fees incurred by Shepherd Oil Company.
Acknowledgement
Signature*
Name of Signatory*
First Last
Title*
Today's Date*
MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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Shepherd Oil Company

1831 S Main Street

Blackwell, OK 74631

1-800-420-4280

IRS Form W-9

Request For Taxpayer Identification Number & Certification

Part 1: Taxpayer Identification Number (TIN)

Part 2: Certification

Uniform Electronic Transactions (UETA) Compliance