W9 Submission Form

Details submitted on this page should match your federal income tax return for the IRS.

Name*

Legally registered business name with the IRS.
Doing Business As*

Name business goes by day to day.
Tax Classification*
Address 1*
Address 2
Address 3
City*
County
State*
ZIP Code*
Phone
Email
Fax
Name of Elephant Customer you are working with

(Or Elephant Claim Number if you have it)
File*
Consent*
Selecting this box and submitting this form indicates you have completed this form accurately and have attached a digital copy of your signed W9. If this form has not been completed fully or your signed form not attached, this may cause delays in processing