Portland, MEO4I03 Newmarket, NH 03857 WHITE. wwiitinn Tava’ “Statitaee COMPANY ACH Authorization Form \ here by authorize Paul G, White Tile Co, nc. to initiate account payeble payments through automatic bank deposits and, if necessary, adjustments to my account for payments made in eor. ‘COMMERCIAL RETAIL ‘COMMERCIAL TH 444 Riverside industrial 50 Allen Avenue 11 Forbes Rd. Bank information and Authorization for ACH Company name: inlerslale Floors conlragfor Ie Company phone number: W727 3422 [Company remit address: 24. SleVenSon koas_Killery HEO3904 Name of Bank: [TD bank Name on the Account: Eeicson Hiche| pasananto Sancher Bank address: 208% wWoshbury ave, Newinafon Mi o3eo1 | Bank phone number: G03 433 2801 Account Type: business checking, accounl Account number: 4243160215 Routing number: O119000F1 (Company contact: Michael! Sanchex Title: Owner ‘Contact phone number: Fit F241 322. Contact email address: wnlecsHoors@.amail.com Date: o3/i Authorized Signature: you have any question regarding the ACH outhorz To accountng ot 207-797-7349 Please be sure to email the completed ACH authorization form to accountspayable@paulwhitecompany.com , Fax to 207-797-0222, or mail it too: Paul G, White Tile Co,, Inc 444 Riverside Industrial Parkway Portland, ME 04103, Please note this form will have sensitive information please try emailing or faxing first to keep the information as safe as possible,mn We (Rev. October 2018) iret 0 eas ‘havens ere ie u ic |N Request for Taxpayer Identification Number and Certification >> co to wm.ire.govFormW0 for instructions and the latest information. “Rar as SSO GVO HS ae ot] Rare eae OTA dort onve Ts re Ba Give Form to the requester. Do not ‘send to the IRS. Fotewing seven boxes shgemerber Lie Print oF type. See Specie instructions on page 3. | 7 omer ee nrctons Adress grbr, Set and ail oF aa ro | Seana Zt Slevenson ed Apl 2 "ak apropae boxer oor ax Gascon ol hm psn whose ares ened ante 1, Check ory one othe EF cannon ptscree Ch comonten Clscapenion C] remain *Baretane ode oy ye Feructons on pape 3: Di ranvostate Exar pay code a) [Dita ity company Enter the ox lsat (0-C copain, SS corporation, P=Panneren] > Note: Gneck he appropri ox nthe ne abo rhe ax laafeaton fhe sngle-rabar owner. 09 csi IED the Lc casted ea a angn-ramber LC tat i lragudd or the ower uous te owner of te LL. ‘ett {LS fat sna derogarog or fe nar or US fda tx purses, tari, a sgerbe LC ta {Fctregarde rm he owner Sous check te aporoprate box rte tax casitoaten sown. Exarton from FATCA reporting code far | nsscmmanaser ti) goa a a acarse atonal 0 904 Sen gan etre Kittery re ee [EI __Taxpayer identification Number (HN) Enter your TIN in the appropriate box. The TIN provided must match the name given on ine 1 Yo avoid beckup withheding, For individuals this generally your social secu numer (SSN). However, fora Fesident aie. sole proprietor, or regard entity, se te instructions for Part later. For other -| ntti, itis your employer entiication number (EN) Mf you do nat have a umber. see How to get a TWN, ate. No ‘Number To Give the Requester for guidelines on whose number to enter. the aoccunt i in mors than ono name, $99 the instructions fre 1. Also see What Name and [Sasi aay namiber | (LEnotyerionineation name 36] -2ialolobk bb [EM —Corication ‘Under penalties of perry, |coriy tat 1. The number shown on this form is my comect taxpayer identification number (or | am waiting for a number to be Issued ome}; and 2 Lam not subject to backup witmhokding because (a am exempt om backup withholding, or 2) | have pot been notified bythe Intl Revenue ‘Senos (RS) that | am subject to backup withholding asa result of fale te report all interest or dividends, orc} the IRS has noted me that | am ro longer subject to backup witinoaing a 3.1m a US. czen or other U.S. person (defined below); and 4. The FATCA codes) entered on this form any) Inccating that am exempt am FATCA reporting is comact CCeritcaton instructions. You must ross out 2 above you have been notes by the IRS that Yu ae curently subject o backup withholding because {you nove faled to report al narest and ivsends on yout ax run, For rel esate ansactons, tan 2 doesnot apply. Fr mortgage interes ai, ‘auton abandonment sects ropa, arelaln of bi, cero oan ncaa raanert arargrer (RA ad oral, ayn Sign 5 Here _| Ox seme oar 03/15 / 202.| General Instructions * Frm 1090-DV (iden, ning those frm teks or maa Section references ae othe Intornal Revenue Code uness otherwise ted Future dew Fr the latest information about developments related to Form W-9 and its instructions, such as legion enacted ‘tor they were published, go to ww. gow/FormW Purpose of Form ‘An individual or entity (For W-9 requester) who is required to fle an Information return with the IRS must obtain your comect taxpayer ‘entiication number (IN) which may be your social security number (SSN), alvidual taxpayer entiation number (TN), adoption {axpayer ldentfication number (ATIN), of employer Identification number (BN), to report on an information retum the amount paid Yo you or ther frount reportable on an Information retun_ Examples of information Tetum include, but are rot ited to, the folowing. ‘+ Form 1099:INT (interest eared or paid) ‘unds) ‘+ Form 1098-MISC (various types of income, prizes, awards, or gross proceeds) + Form 1088-8 (stock or mutual fund sales and certain other transactions by brokers) + Form 1099-S (proceeds rom real estate transactions) + Form 1099- (merchant card and third party network transactions) * Form 1098 (home mortgage interest), 1098-€ student ian intrest, $1088. tuiton) + For 1098- (canceled debt) ‘+ Form 1098-A facquistion or abandonment of secured property) Use Form W-9 only i you are a U.S. person fnclucing a resicent ‘lo, to provide your correct TW If yu donot ret Form W-9 othe requester with a TIN, you might ‘be subject 0 backyp witnhokting. See What ls backup withholding, ator Ga Na 10287" Farm WB fev 10258)