Intake
Please provide the taxpayer and banking details below so we can set you up as a payee. Your information is handled securely.
Intake Form (W9)
Preview of our secure intake — online submission is launching soon.
Is this an individual or an intity? *
Individual
Entity
Payee Name *
First
Middle
Last
Email *
Entity Name *
Federal Tax Classification *Options: Individual/sole proprietor, C Corporation, S Corporation, Partnership, Trust/estate, Limited Liability Company – taxed as C Corporation, Limited Liability Company – Taxed as S Corporation, Limited Liability Company – Taxed as Partnership
Address *
Street Address
City
State / Province
ZIP / Postal Code
Country
SSN / EIN *
Banking Information
Bank Name *
Type of Account *
Checking
Savings
Routing Number *
Account Number *
Under penalties of perjury, I certify that: *✍️ Certification & Consent • 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 • 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 • I am a U.S. citizen or other U.S. person (defined below). In addition, by signing below I give permission to Brookhaven Consulting, LLC and any of its affiliates, including Brookhaven Legal, LLC, and Brookhaven Tax & Accounting. E-Sign Acknowledgment By providing an electronic signature, you agree it is the legal equivalent of your handwritten signature to the extent permitted by law.
SUBMITSOON
Online submission is launching soon — reach us directly in the meantime.
Get StartedPrefer to talk first? Call 762-847-0126.
