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Broker Application Packet

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Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
3.2020
Broker Application Packet
Thank you for submitting your Broker Application to Maxim Commercial Capital, LLC.
For the fastest service, please complete the following attached information:
Broker Application
Broker Agreement
Broker W9
Please email your application package to:
Dana Freeman
Director - Broker Relations
Email: dana@maximcc.com
Phone: (213) 425-3163
Driver's License / Identification Card
Voided Check from Business Bank Account
ATTACH COPIES OF:
BROKER APPLICATION PACKET
Company Name
Street Address
Mai
ling Address
City
State Zip
Phone
Fax Email Website
Years in Business Contact Person
Title
Type of Entity (check one) Corporation S-Corp Partnership Sole Prop. LLP LLC LTD
Total Number of Employees Salespeople Support Other Federal ID #
Resale # Registered State
Numb
er of Offices and Locations
Own
er/Principal Name
SSN Address
Owner/Principal Name
SSN Address
Owner/Principal Name
SSN Address
Please list the primary funding
sources with which you currently work.
Company Contact
Phone
Email Annual Volume
Comp
any
Contact
Phone
Email Annual Volume
Comp
any
Contact
Phone
Email Annual Volume
What
types of financing products do you broker?
Total
Annual Financing Volume
Average Transaction Size
Credit Focus (A-D)
Geographic Territory/Focus
Fina
ncing Product/Equipment Focus
Has your company ever had a funding source terminate its business relationship? No Yes (please explain below)
By signing below, applicant warrants that all information given above is true and correct; and that Maxim Commercial Capital, LLC may obtain any information
necessary pertaining to this application, including but not limited to owners and officers.
Signature Title Date
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
click to sign
signature
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BROKER AGREEMENT
This Broker Agreement ("Agreement") is made by and between
("Broker") and Maxim Commercial Capital, LLC ("Maxim") with respect to financial transactions ("Transactions")
including but not limited to leases, EFAs and proposed lease and EFA transactions submitted or referred to Maxim
by Broker. The parties hereby agree as follows:
1. Referral, Sale and Assignment of Transactions. Broker may, from time to time, refer or submit third parties
("Customers") seeking financing for equipment or offer to sell completed leases and/or other financing agreements in
respect of equipment to Maxim. Maxim may, in its sole and absolute discretion, enter into financing or leasing
Transactions with such Customers or purchase such completed Transactions, and Maxim may, in its sole and absolute
discretion, reject any Customer referred to it and any Transactions presented to it for sale.
2. Compensation to Broker. In return for Broker's compliance with this Agreement and its efforts in connection with
any Transaction submitted by Broker which is approved, executed, and funded in full by Maxim, Maxim shall promptly
pay Broker such fee as is specifically agreed between Maxim and Broker at such time in writing.
3. Scope and Duration. This Agreement shall be effective from and as of the date on which Broker submits (or
submitted) its first proposed Customer or financial Transaction to Maxim for consideration and shall apply to all
financial Transactions referred to Maxim and/or submitted for sale to Maxim by Broker until such time as this
Agreement is terminated or superseded by a subsequent agreement. This Agreement may be terminated at any time
by either party upon written notice to the other party; provided, however, that the rights and obligations of the
parties hereunder with respect to Transactions and Customers referred to Maxim prior to termination of this
Agreement shall survive such termination. If so terminated, this Agreement shall automatically be reinstated in full
force and effect upon Broker's referral to Maxim of subsequent Transactions or Customers.
4. Disclosure of Information. Broker shall, in connection with each Customer, financial Transaction, lease, or proposed
lease Transaction submitted to Maxim, promptly disclose to Maxim all material information known to Broker
concerning such Transaction, including, but not limited to, ALL INFORMATION REGARDING THE CUSTOMER AND ITS
OWNERS, PRINCIPALS, AFFILIATES, AND GUARANTORS such as the financial condition, credit reports, credit
references, bank and trade references, the equipment to be leased or financed, the vendor(s) or supplier(s) of such
equipment, and such otherinformation as Maxim may request from Broker. The Broker's obligation promptly to
provide Maxim with the foregoing information including any changes thereto or updated information, shall continue
throughout the duration of Maxim's evaluation of the Customer, application, or Transaction and, if approved by
Maxim, the term of the subsequent financial Transaction between Maxim and the Customer. Broker acknowledges
that the intentional alteration of an application, documents, or any information provided to Maxim or the failure to
provide to Maxim any material information known to Broker with regard to a Customer or Transaction submitted by
Broker constitutes fraud for which Maxim may seek all remedies available to it under this Agreement or under law.
5. Documentation. All Transactions approved by Maxim shall be documented to Maxim's complete satisfaction in such
form as shall be acceptable to Maxim, in Maxim's sole discretion. Broker shall not alter the text of any documents or
forms provided by Maxim without prior written consent from an officer of Maxim. Broker agrees to enter into and/or
provide such other agreements and documents (both before and after each Transaction is finalized) as may be
reasonable and necessary to complete the Transaction or effectuate the intention of the parties.
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
6. Previous Contact. In the event that Broker provides Maxim with an application covering the leasing or other
financing of equipment for a Customer with whom Maxim has previously established contact regarding such
equipment, Maxim shall not be obligated to pay Broker any fees or commissions relative to Maxim's leasing or
financing of said equipment to such Customer. Maxim will provide Broker with proof of such prior contact upon
written request.
7. Broker Representations, Warranties, and Covenants.
7.1 Broker hereby represents, warrants, and covenants that:
(a) Authorization by Broker. Broker has full power and authority to enter this Agreement; this Agreement has been
duly authorized by all necessary action, corporate or otherwise, on the part of Broker; and this Agreement when
executed on behalf of Broker will constitute a valid and binding agreement enforceable against Brokerin accordance
with its terms.
(b) Broker Information. All of the information set forth in the broker application provided to Maxim is true, accurate
and complete. Broker shall notify Maxim in writing of (i) any change in its name, (ii) any change in its address,
telephone number, fax number, or other contact information, (iii) any material change in its ownership, (iv) the
commencement of any criminal proceedings against Broker or any of its employees, (v) the commencement of
bankruptcy proceedings by or against Broker or any of its owners or principals, (vi) the issuance of a tax lien or legal
judgment against Broker or any of its owners or principals, and (vii) any material change in its financial condition or the
financial condition of its owners.
(c) Permits, Licenses. Broker has all necessary permits, authorizations, and licenses required under current laws and
regulations to carry on its business as currently conducted and as contemplated pursuant to this Agreement.
(d) Compliance with Laws. Broker has conducted and will conduct its business in accordance with all laws and
regulations which are applicable thereto.
(e) Qualification of Broker; Inspection of Records. Broker shall, from time to time, upon written request from Maxim,
submit such information to Maxim as Maxim deems appropriate in order to assure Maxim that Broker meets Maxim's
standards with respect to its qualifications to transact business with Maxim including, without limitation, compliance
with all applicable laws and regulations. Broker, on its own behalf and on behalf of its owners and principals, hereby
agrees that Maxim may from time to time conduct such investigations and due diligence as Maxim deems necessary in
order to determine Broker's qualifications and creditworthiness including, without limitation, obtaining credit reports,
financial statements, bank references, and trade references for Broker and its owners and principals. Broker agrees
that Maxim may, at its option during ordinary business hours and at Broker's place of business, peacefully inspect
Broker's records with respect to any Transaction submitted by Broker to Maxim.
7.2 With regard to each application or Transaction referred or submitted to Maxim, Broker further represents,
warrants, and covenants that at the time of such referral and thereafter:
(a) Transaction Documents. Broker shall promptly deliver to Maxim all manually executed originals of all Transaction
documents in the possession of Broker. All documents provided in connection with an approved Transaction shall be
duly executed by the appropriate parties, said parties shall have been duly authorized to execute said documents, and
said documents will be enforceable in accordance with their terms.
(b) Customer Information. Broker shall disclose to Maxim all owners and affiliate entities of Customer known to Broker
as well as any existing or historical relationship between Broker and Customer, its owners, guarantors, or affiliates.
Broker shall provide to Maxim in theirentirety all credit applications, tax returns, financial statements, and
information together with any bank, trade, and credit ratings received by Broker from or for a Customer, its owners, or
guarantors. All such applications, returns, financial statements, information, and ratings shall, to the best of Broker's
knowledge after due inquiry, be accurate and correct and shall fairly represent the financial condition of such
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
Initials
__________
Customer, its owners, or guarantors at the time of submittal. Broker shall not delete or alter any information,
applications, documents, returns, financial statements, or ratings provided to Maxim. Broker shall provide to Maxim
all information known to it regarding any and all defaults, liens, crimes, bankruptcies, delinquencies and frauds
pertaining to any Customer, its owners, or its guarantors or to any vendors or suppliers of equipment to Maxim or
Customer.
(c) Commercial Nature of Transactions. All applications and Transactions submitted by Broker to Maxim shall be for
business or commercial purposes only, and shall specifically not be intended for personal, family, or household
purposes.
(d) Authorization for Credit Investigation. Broker shall obtain and assign to Maxim, full authorization from any
Customer, its owners and its guarantors to perform such legal credit investigation activities pertaining to Customer, its
owners and its guarantors as may be necessary to appropriately evaluate a financial Transaction or proposed
Transaction, including but not limited to the acquisition and evaluation of personal credit reports and credit scores,
and Broker represents that such authorization has not been revoked by Customer, its owners or its guarantors. If
Maxim so requests, Broker shall forward to Maxim the original of the credit application and any other material signed
by Customer, its owners, and its guarantors.
(e) Disclosure of Other Transactions and Submissions. Each Transaction approved by Maxim and the corresponding
documents executed by Customer and Maxim and/or provided to Maxim by Broker shall be the sole and complete
agreement with regard to the lease or financing of the equipment described therein, and there will be no other
agreements in force with respect to such equipment or the lease or financing thereof except such agreements, leases,
or financings as are expressly disclosed to Maxim in writing. Broker shall disclose to Maxim the identity of any funding
source other than Maxim to whom Broker has submitted an application or Transaction, the date of such submission,
and the disposition by such funding source.
(f) Other Customer Financings. Broker shall disclose to Maxim in writing any and all financial Transactions completed
within the past six months and/or currently contemplated in the foreseeable future of which it is aware that pertain to
any Customer, its owners, or guarantors and, if Maxim approves a Transaction with a Customer, Broker shall promptly
update Maxim in writing as to any changes pertaining to such Transactions or proposed Transactions.
(g) Payments to Broker. Broker shall disclose to Maxim in writing all monies collected from a Customer, its owners, its
guarantors, or any affiliate or from any vendor, supplier, or other party involved with a proposed Transaction within
the past six months and all amounts remaining due to, or expected to be collected by, Broker and/or any employee of
broker, equipment vendor or other interested third party from a Customer, its owners, its guarantors, or any affiliate,
and, if Maxim approves a Transaction with a Customer, Broker shall promptly update Maxim in writing regarding any
changes in such funds due and/or collected. Broker shall hold in trust and promptly remit to Maxim any payment
owed to Maxim by a Customer, its owners or guarantors or any vendor but received by Broker.
(h) Source of Transactions. Broker shall disclose to Maxim the manner and source through which it became aware of
each Customer and Transaction. In the event that a proposed Transaction submitted to Maxim is "re -brokered", as
that term is generally understood in the industry, Broker shall identify in writing said lease Transaction as being re -
brokered, and shall disclose to Maxim the identities of the parties (including, without limitation, addresses, telephone
numbers, tax ID numbers, and names of principals) from whom Broker accessed the Transaction and any existing or
historical relationship between Broker and such parties. Without limiting the generality of the foregoing, the term "re -
brokered" includes all Transactions submitted wherein it is contemplated that any remuneration will be paid by Broker
to any party other than Broker's employees, in the event that the Transaction is accepted and funded by Maxim.
(i) Representations to Customer. Broker shall accurately represent each Transaction to the Customer, its owners, and
its guarantors and to any vendors or suppliers of the equipment.
(j) Enforcement Assistance. Broker will, upon reasonable request from Maxim and at Maxim's expense, assist Maxim in
gathering information, contacting a Customer, repossessing any equipment and/or otherwise enforcing Maxim's rights
in respect of a Transaction.
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
Initials
_________
(k) Notice to Applicants: Regulation B. To the extent that federal or state laws and regulations (including, but not
limited to, the Equal Credit Opportunity Act, sometimes known as "Regulation B") require that certain notices be
provided to proposed lessees or borrowers, including, but not limited to, disclosure of the right to request specific
reasons for credit denial and notice of action taken and statements of reasons for taking such action, Broker
represents and warrants that all such notices will have been provided or will be provided at the appropriate time to
the proposed lessee or borrower, and Broker shall supply Maxim with written verification thereof upon request.
8. Breach of Agreement.
8.1 Repurchase by Broker. If any of Broker's representations, warranties, covenants, obligations, or duties set
forth in this Agreement is breached by Broker, then, promptly upon receipt of written demand from Maxim, Broker
will repurchase any lease or other financing to which the breach relates and all related equipment. The repurchase
price in each case shall include the unpaid balance of such lease or other financing (which shall include (a) all amounts
then due but unpaid plus (b) the sum of all remaining rental payments through the end of the lease term and any
assumed residual, if applicable, discounted to its present value using a discount rate of 5%), plus any expenses
(including attorney fees and collection costs) incurred by Maxim in connection with enforcing (i) the lease or other
financing document and any guaranties or other related agreements or (ii) this Agreement. The equipment will be sold
"AS IS, WHERE IS" and both the lease (or other financing) and the equipment will be sold without any warranties
whatsoever
except a warranty against liens or encumbrances created by or through Maxim other than the rights of the lessee
under the lease.
8.2 Indemnity. Broker shall indemnify, save, and hold Maxim harmless from and against any and all claims,
suits, losses, damages, expenses, or liabilities (including, without limitation, court costs and attorney's fees) which
Maxim may incur, pay, or suffer as a result of or in relation to (i) any breach of this Agreement by Broker, (ii) any
misrepresentation made by Broker herein or in any information provided by Broker to Maxim with regard to a
Customer or Transaction, or (iii) any other acts or omissions of Broker, its principals, employees, assigns or
representatives. Broker agrees, at Maxim's option and Broker's expense, to defend Maxim against any claims, suits
and actions, including negligence and strict liability, whenever made for losses or injuries related to Broker's breach of
this Agreement. This indemnity is a continuing indemnity and shall survive termination of this Agreement.
8.3 Rights Cumulative. Maxim's repurchase and indemnity rights are cumulative and in addition to all rights
otherwise available to Maxim under law. No forbearance or delay in the exercise of such rights shall operate as a
waiver.
9. Customer Payment Default. If Maxim takes steps to enforce its rights in respect of a Transaction as a result of a
default by Customer in the making of its first Monthly Payment following the funding of the Transaction or as a result
of the discovery by Maxim that any payment received prior to funding in respect of advance payments, security
deposits or fees has been dishonored, then Brokerwill, promptly upon receipt of a request from Maxim, refund any
fee paid to Broker in connection with the Transaction pursuant to Section 2 of this Agreement or otherwise.
10. Authority of Broker. This Agreement does not create an agency, partnership, or joint venture relationship
between Maxim and Broker. Broker is, and shall act as, an independent contractor. Broker shall have no authority to
incur any obligations or to make any statements or representations on behalf of Maxim, or to bind or commit Maxim
in any manner, or to make, alter, or execute any document or agreement provided by orentered into on behalf of
Maxim. Broker shall not use Maxim's name or any of Maxim's trademarks as part of its firm, trade, or corporate name.
Broker shall not accept service of any legal process for, or employ attorneys to defend, any action that may be brought
against Maxim.
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
Initials
_________
11. Acts of Representatives. Broker acknowledges and agrees that all duties and responsibilities of Broker under this
Agreement shall extend and be applied to all individuals orentities acting on Broker's behalf. Broker specifically
acknowledges and agrees that in the event that it delegates to others any of its obligations hereunder, such as
obtaining documentation or making other arrangements with regard to a Transaction, Broker shall remain full y
responsible for any and all such actions as if Broker had taken such actions itself.
12. Expenses of Broker. Maxim shall not be liable for expenses incurred by Broker in connection with any Transaction
submitted by Broker. Any and all such expenses shall be Broker's sole responsibility and obligation.
13. Limited Power of Attorney. Broker hereby irrevocably grants to Maxim power of attorney to file such Uniform
Commercial Code financing statements in Broker's name as Maxim deems necessary or desirable in order to record
any security or ownership interest acquired by Maxim in connection with any Transaction sold to Maxim pursuant to
this Agreement. Broker consents to Maxim's disclosure of this Agreement to third parties as evidence of the grant of
this power of attorney.
14. Choice of Law and Venue. This Agreement shall not be effective until signed by Maxim in its office in the State of
California. This Agreement shall be considered to have been made in the State of California and shall be interpreted in
accordance with the laws and regulations of the State of California. Broker agrees to California jurisdiction with
respect to any action, suit, or proceeding arising out of this Agreement, and concedes that it transacted business in the
State of California by entering into this Agreement. In the event of legal action to enforce the te rms of this Agreement,
Broker agrees that venue may be laid in Los Angeles, California or the County of Los Angeles, California and Broker
consents to personal jurisdiction in either state or federal court. Each party hereto irrevocably waives, to the fullest
extent permitted by applicable law, any and all right to trial by jury in any legal proceeding arising out of or relating to
this Agreement.
15. Attorney Fees. If it becomes necessary for either party, either directly or indirectly, to enforce the provisions of
this Broker Agreement by legal action or employ an attorney for collection of any monies due hereunder, then the
prevailing party shall be entitled to recover, in addition to court costs and other costs of such proceedings, reasonable
attorney fees incurred in enforcing such provisions, including those incurred prior to initiating litigation, as well as in
the trial and appellate courts or the United States Bankruptcy Court.
16. Waiver. No waiver of any provision of this Agreement shall constitute a waiver of any other provision, whether or
not similar, nor shall any waiver constitute a continuing waiver. Failure to enforce any provision of this Agreement
shall not operate as a waiver of such provision for any other provision.
17. Notices. All notices, requests, demands and other communications required or permitted hereunder shall be in
writing and shall be deemed to have been duly given if delivered by hand, mailed, (certified mail with postage prepaid)
or delivered by any express delivery service which provides for receipted delivery to the address for each party set
forth beneath its signature block below or to such other address as such party shall have furnished to the other party
in writing.
18. Miscellaneous. This Agreement embodies the entire agreement of the parties hereto. There are no promises,
terms, conditions, or obligations other than those contained herein. This Agreement shall supersede all prior
communications, representations, or agreements, either oral or written, between the parties. This Agreement may be
amended, modified and supplemented only by written agreement between the parties hereto which states that it is
intended to be a modification of this Agreement. Broker may not sell, transfer, or assign this Agreement or any of its
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
Initials
__________
rights and/or obligations under this Agreement without Maxim's advance written consent. This Agreement shall be
binding upon the successors and assigns of Broker and shall inure to the benefit of the successors and assigns of
Maxim. Broker agrees that all of the rights arising under this Agreement (including indemnity rights) shall survive any
expiration or termination of this Agreement. The parties agree that a signed faxed version of this Agreement shall be
deemed to be of the same force and effect as an original counterpart of a manually signed version of this Agreement.
In witness whereof, the undersigned parties have caused this Agreement to be executed by their duly authorized
representatives.
Broker Company:
Signature: Date:
Print Name:
Title:
Maxim Commercial Capital, LLC
Signature: Date:
Print Name:
Title:
Maxim Commercial Capital, LLC | 11620 Wilshire Boulevard, Suite 540 | Los Angeles, CA 90025
877-77-MAXIM | 877-776-2946 | www.maximcc.com
Form W-9
(Rev. November 2017)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
▶
Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
See Specific Instructions on page 3.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
▶
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions)
▶
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
6 City, state, and ZIP code
Requester’s name and address (optional)
7 List account number(s) here (optional)
Part I 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 II 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.
Sign
Here
Signature of
U.S. person
▶
Date
▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X
Form W-9 (Rev. 11-2017)
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Broker Application Packet

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