1. No category

MN Rev 6
TENANT PLACEMENT AGREEMENT
This Tenant Placement Agreement (“Agreement”) dated
__________, between
_______________________________________ (“Owner”) of the property or properties (“Property”)
described in Exhibit A and Hayden & Company, LLC d/b/a/ Renters Warehouse (“Broker”), a
Minnesota corporation, located at 6101 Baker Road, Suite 200, Minnetonka, MN, which is a licensed
real estate brokerage company in the state of Minnesota.
In consideration of the mutual terms of this Agreement, the parties agree as follows:
1. Term of Agreement: This Agreement begins on _________________ and ends on
________________ (not to exceed six (6) months), or upon tenant placement or termination
according to the terms of this Agreement, if either such event precedes the end date.
2. Agreement to List and Market Property: Broker shall have the non-exclusive right to list
and market the Property described below for lease, including any personal property left by
Owner on site (“Property”), as described on the attached Exhibit A.
3. Representations, Role and Duties of Broker
a. General role of Broker: While Broker will engage in efforts to help procure a Tenant for
Owner’s Property, this is not a Property Management Agreement and the role of Broker
pursuant to this Agreement shall be to list and market the property to find a prospective
tenant.
i. Facilitator Relationship: Broker is facilitator, as the term is defined by
Minnesota law as explained in the Agency Relationships in Real Estate
Transactions form, attached as Exhibit B. Broker, as facilitator, does not owe
any party any fiduciary duties as described in Exhibit B, except for
confidentiality. Nothing in this Agreement shall be construed as creating a
partnership, joint venture, agency, or any other relationship other than facilitator.
b. Listing and Marketing: Broker will list and market the Property through various
resources deemed appropriate to Broker and advantageous to Owner, which may include
print, internet and web advertising, including social media, real estate aggregators or
multiple listing systems (“MLS”), and other similar resources.
c. Showings and Lease Negotiation: Broker shall conduct showings to prospective tenants,
and will assist in efforts to procure a lease agreement for Owner, which shall include:
i. Collecting tenant information and conducting any tenant screening or
background checks deemed by Broker to be appropriate or requested in writing
by Owner.
ii. Assisting Owner in the preparation of the lease agreement, including negotiating
terms and conditions of the lease as instructed by Owner, and ensure that any
lease agreement and related documentation agreeable to Owner are properly
executed by Owner with copies delivered to Owner and tenant.
Owner Initials ________
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iii. Collecting initial monies paid by tenant and forwarding the same to Landlord,
including 1st rent payment, security deposit, pet deposit, and other deposit or fee
related to initial tenancy.
d. Tenant Warranty: Broker shall provide to Owner the “Tenant Warranty” described in the
attached Exhibit C to this Agreement, subject to the terms and conditions described
within such Warranty description.
e. Limited Scope Agreement: Broker shall not manage Property for Owner nor shall
Broker perform maintenance or any other like duties unless Broker and Owner
enter into a separate Property Management Agreement. Broker’s sole responsibility
is to procure a tenant acceptable to Owner, which shall serve as the basis for Broker’s
compensation. Upon Owner’s acceptance and execution of lease agreement, Broker shall
be relieved of all responsibilities and obligations, except to remit to Owner any copies of
agreements or monies specified in this Agreement. Owner acknowledges that by
entering into this Agreement, Broker does not guarantee that Property will be leased.
Broker will use reasonable efforts to procure a tenant, but the availability of a tenant will
be based in large part on Owner’s lease terms and whether the stated terms are market
competitive.
NOTICE: THE COMPENSATION FOR THE SALE, LEASE, RENTAL, OR
MANAGEMENT OF REAL PROPERTY SHALL BE DETERMINED BETWEEN EACH
INDIVIDUAL BROKER AND THE BROKER'S CLIENT
4. Broker Compensation and Expenses
a. Commission due for Procuring Tenant: Any tenant to whom Owner leases a property,
who is identified by, recommended by, or found by Broker during the term of this
Agreement is deemed to have been “procured” by Broker. Once Owner enters into a
lease with any tenant procured by Broker during the term of this Agreement or within 3
months before or after the expiration of this Agreement, regardless of when such lease is
secured, a commission is due to Broker as identified below. For this override clause to
be effective, Broker must provide to Owner, within 72 hours after the expiration of the
listing agreement, a protective list identifying the potential tenant who displayed an
interest in or made an inquiry about the Property. In the event a pre-lease deposit, hold
agreement, or lease reservation is signed or approved by both Owner and Tenant a
commission is due to Broker as identified below.
b. Amount of Compensation: Owner shall pay Broker a commission as follows:
i. Upon Owner’s decision to lease to a prospective Tenant procured by Broker,
Owner shall pay to Broker:
1. An amount equal to 1 full month’s rent if Owner and Tenant execute
a lease with a term of 17 months or less;
2. An amount equal to 1.5 month’s rent for all leases 18-35 months in
duration;
3. An amount equal to 2 full month’s rent for an executed lease with a
term of 36 months or longer.
4. If Owner and Tenant execute a lease-option agreement, rent-to-own
agreement, or Contract for Deed, Owner shall pay Broker an
amount equal to 2 full month’s rent or Contract for Deed payments.
Owner Initials ________
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Check here ¨ and initial if you understand and agree to the
above-described lease commission Owner Initials: ______
ii. The commission described above shall be due and immediately payable from
Owner to Broker upon execution of a lease agreement or other agreement or
document referenced above. Month's rent commission rate is calculated
excluding any maintenance rent credits allocated to Tenants in 'Exhibit A' of the
Renters Warehouse Lease agreement.
iii. Additionally, Owner shall pay to Broker a $350.00 lease renewal fee at
execution of any lease renewal executed between Owner and any tenant
procured within this agreement. Upon receipt of payment of the lease renewal
fee from Owner to Broker, Broker shall prepare and negotiate new lease or lease
addenda terms and conduct background and credit checks upon Owners request.
Owner is not responsible for payment of the lease renewal fee to Broker if the
Owner renews the lease without Broker’s assistance.
iv. In the event the Owner shall procure a tenant on their own, Owner may choose to
use Broker’s lease forms, addenda, and background check services for a fee of
$350.00. The regular commission associated with lease length would no longer
be due. This $350.00 fee may be waived by Broker if Owner uses Owner’s own
lease form and does not require forms or additional service from Broker. In
order to qualify for this discounted commission, Owner must have procured and
shown the property to the prospective tenant, without the involvement of Broker.
In the event Broker showed the property to Tenant, prior to Owner showing the
property, Broker has procured Tenant for the purposes of commission being due
from Owner. If Owner has procured the Tenant, the Broker will not provide the
Tenant Warranty otherwise made available by this Agreement.
v. The compensation section (paragraph 4 of this Agreement) shall survive the
termination of this Agreement if Owner leases or renews a lease with a tenant
procured by Broker.
5. Representations, Responsibilities and Duties of Owner
a. Condition of Property: Before advertising or marketing a Property for lease, Owner
must have the Property in clean and marketable condition, as determined in the sole
judgment of Broker. Broker accepts no responsibility for ordering, arranging, or
coordinating any vendor services (including but not limited to cleaning, maintenance, or
repair services) or rent collection services. Owner certifies that all heating, cooling,
plumbing, electrical systems, and all appliances are in good working condition and
Owner shall be responsible for the maintenance or replacement of same. Owner certifies
that the roof, windows, and overall structure of Property is sound, that the Property is
habitable (fit for rental occupancy) and the property has no water intrusion, mold, pests,
rodents, or other adverse conditions that may impact Tenant’s occupancy, unless Owner
has disclosed to the contrary in writing to Broker.
b. Compliance with Law and Rental Restrictions: Owner certifies that Property is in
compliance with all applicable laws, ordinances, and regulations of all governmental
authorities. Owner is solely and individually responsible for verifying and determining
whether the lease or rental of the Property requires approval from a common interest
community (CIC) or other association, approval or rental permit/license from the city,
municipality or other authority, and that Owner has obtained any and all necessary
Owner Initials ________
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approvals or permits before the property is advertised by Broker as available for lease.
Owner shall attach proof of ownership (i.e. copy of deed, public records, or HUD, or
other closing statements) to Agreement or within 24 hours of written request by Broker.
Owner certifies that the Property is not restricted by any provisions within a mortgage,
contract for deed, or any other agreement or restriction which would prevent the Owner
from leasing the Property according to this agreement. Owner shall be solely
responsible for complying with Landlord Tenant laws, including Minnesota Statutes
504B. For more information, Owner is welcome to review the Minnesota Attorney
General’s
Office
Landlord
Tenant
Handbook,
found
here:
http://www.ag.state.mn.us/consumer/housing/lt/default.asp
c. Compliance with Declaration of Condominium, Taxes & Assessment: If Property is a
condominium/townhome or governed by a Homeowner’s Association, any lease
negotiated on Owner’s behalf shall be subject to the Association Rules and Regulations.
Owner agrees to provide copies of any rules, regulations, or restrictions to Broker and to
Tenant, which may impact a prospective Tenant’s occupancy. Owner is individually
responsible for providing prospective Tenant, association, or both, with any and all
applicable documentation, approval forms, or the like.
d. Keys and Access: Upon execution of this Agreement, Owner must provide a minimum
of 2 sets of keys for each door lock, security/pool keys, mailbox keys, garage door
openers, gate cards and security passes, and shall supply Broker with all codes and
combinations for locks keypads, etc., if any. Owner certifies that Broker is authorized to
access the Property and common areas (if Property is within an association or similar
community where access to common areas is relevant).
Owner _____ DOES or _____ DOES NOT
authorize Broker to place a lockbox on the Property
e. Listing for Sale: Owner is authorized to list the Property for sale with or without Broker,
as this is a non-exclusive Agreement.
At the time of execution of this Agreement, Property:
_____ Is or _____ Is Not listed for sale.
(If “Is” checked, specify brokerage with whom Property is listed:
______________), and term of listing: _______________.
If Property is not currently listed for sale, Owner must immediately inform Broker if
Property is subsequently listed for sale, and Owner shall cooperate with Broker to ensure
the property may continue to be listed for lease.
f.
Inventory, Damages or Missing Items: Owner shall provide Tenant with a written
inventory of personal items and furnishings within the Property which will remain in the
Property during lease term. Broker is not responsible for damage to the premises or
missing, lost, or damaged items or furnishings under any circumstances, including, but
not limited to, theft, switching out of items, vandalism or negligence of Tenant(s), their
guests or third parties. Owner is responsible for sufficiently securing valuables or
personal items left in the Property in any manner deemed appropriate by Owner.
Owner Initials ________
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g. Lease Execution, Move-in and Management: Owner shall review and execute any lease
presented by Broker and acceptable to Owner, and shall personally coordinate and
manage the move-in inspection, and shall maintain responsibility for any and all ongoing
property management, property maintenance, or tenant communication once the lease
has been executed unless Owner has chosen to enter into a Property Management
Agreement with Broker, in which case Broker may be responsible for these services
according to the terms of such separate agreement.
h. Lease Deposits and Security Deposits: In the event that a lease reservation, prelease
deposit, hold agreement, or security deposit is required, Broker is initially responsible
for collection, safeguarding, and return of such deposits to any tenant in accordance with
applicable law, unless otherwise forwarded to Owner, at which point Owner shall
assume and becomes responsible for collection (if necessary), safeguarding, and return
of such deposits to any tenant in accordance with applicable law. The Broker shall
collect all monies initially required for tenancy by prospective Tenant on behalf of
Owner, however, once collected, Broker shall issue a receipt confirming all amounts
paid by tenant and release to owner all net proceeds due to Owner, after deducting from
such net proceeds any and all commissions and/or fees due from Owner to Manager.
Broker is authorized to apply initial funds collected, including any payments collected
on behalf of Owner, to satisfy commissions and/or fees to Broker. To the extent the
commission or fees due from Owner to Broker exhaust the funds paid by Tenant, Owner
shall be solely responsible to replenish, safeguard, and/or return to Tenant any deposit or
other funds for which Owner is responsible to Tenant. In the event Owner engages the
services of Broker as property manager, the terms of that Property Management
Agreement shall further modify or supersede this provision, regarding the management
of deposits and funds held by Broker. Any deposits held by Broker may be placed in a
separate account or trust account if required by law. However, if Broker releases
Deposits to Owner upon termination/expiration of this Agreement or for any other
reason, Owner then assumes full responsibility for collection (if necessary),
safeguarding, and return of such deposits. Owner Initials: _________
i.
Lease Rate: Once a lease rate has been identified and agreed to by Broker and Owner,
Owner shall not engage in any marketing or advertising which would suggest a lower
rental rate would be acceptable to Owner, unless Owner has agreed to allow Broker to
market a lower rental rate.
j.
Complaint Resolution: It is agreed that Broker shall have an opportunity to resolve any
concerns or complaints identified by Owner before Owner makes a complaint or adverse
claim against Broker to any third party. Owner agrees to identify in writing any concern
or question Owner has regarding the services provided by Broker and to allow Broker an
opportunity to resolve such concern, before making, filing or publishing any form of
complaint, demand, critique, or dispute against Broker.
k. Additional Owner Representations and Warranties: Owner represents and warrants that
Owner has full power and authority to enter into this Agreement, that there are no
written or oral agreements affecting the Property other than identified in writing to
Broker in advance of execution of this Agreement, and that the information supplied by
Owner is dependable and accurate, and that any loans, notes, mortgages, dues or other
obligations are fully paid and are current without defaults. In the event Owner should
default on any such obligations, Owner shall notify Broker within 14 days of such default.
Such default, or failure to properly identify such default shall constitute a breach of this
Agreement.
Owner Initials ________
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6. No Cancellation Fee for Cancellation: This Agreement contains no cancellation fee. Broker
or Owner may unilaterally cancel this Agreement subject to the requirements contained in
paragraph 11 below. In the event Owner cancels this Agreement before a tenant is procured or a
lease is executed, no compensation, commission, or fees are due to Broker unless Owner and
Broker have executed a separate agreement by which Broker is entitled to compensation or fees.
7. Property Reservation Agreement: In the event Owner enters a Property reservation (or
“hold”) agreement with a prospective Tenant, Broker’s commission is earned at the time of such
Property reservation agreement. In the event either Owner or Tenant choose not to execute a
lease, Owner shall be responsible for properly disbursing any Property reservation funds as
required by law, and for paying Broker’s commission.
8. Tenant Screening and Approval
a. Tenant Approval: Tenant approval is at the discretion of the Owner only, and shall be
subject to all Fair Housing Laws and any and all other municipal, state, and federal law.
Broker shall not approve or deny tenants, except as necessary for the Tenant Warranty.
Broker shall be indemnified and held harmless from any Owner decision, conduct or
statement which violates or is alleged to violate applicable law. Fair Housing Notice:
Owner shall not refuse to lease to or discriminate in the terms, conditions or
privileges of lease to any person due to his/her race, color, creed, religion, national
origin, sex, marital status, status with regard to public assistance, handicap
(whether physical or mental), sexual orientation, or family status. Owner
understands further that local ordinances may include other protected classes.
b. Broker Assistance with Tenant Screening: Broker will assist Owner in identifying the
prospective tenant’s qualifications or background and will relay the information
identified in a credit check, background check, rental history verification, or similar
investigation as authorized by law. Broker shall obtain information identified in a credit
check, background check, rental history verification or similar lawful investigation
through a third-party provider which engages in the business of obtaining such
information. Broker makes no representations and warranties as to the accuracy or
completeness of the information provided by the third-party provider or to the accuracy
or completeness of the information made available to the third-party provider in
conducting an investigation. Broker assumes no liability for any damages, losses, claims,
injury, fees or expenses incurred on behalf of Owner with respect to any information
improperly identified in a credit check, background check, rental history verification or
similar investigation, or omitted information. In the event an investigation of a tenant or
potential tenant fails to identify information or improperly identifies information related
to said tenant or potential tenant’s credit, criminal and/or rental history, Owner agrees to
indemnify and hold Broker harmless from all loss, investigation, suits, damage, cost,
expense, attorneys’ fees, liability or claims that arise as a result thereof.
9. Broker Assumes No Liability: Broker assumes no liability for any damages, losses, theft, lost
rental income, legal expenses, or acts of omission by the tenant as a result of placed tenant.
Broker cannot and will not guarantee tenant behavior, actions, or ability to pay. Broker assumes
neither liability nor responsibility for rental ads placed by third parties. False ads should be
reported to Broker immediately. Broker assumes no liability for any acts or omissions of Owner
or previous Owners or previous brokers. Broker assumes no liability for default by any tenant.
Broker assumes no liability for violations of environmental or other regulations which may
Owner Initials ________
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become known during the term of this Agreement. Any such regulatory violations or hazards
discovered by Broker shall be brought to the attention of Owner, and Owner shall promptly cure
them.
10. Indemnification for Owner or Tenant Acts/Inactions/Omissions
a. Generally: Owner shall indemnify, defend and save Broker harmless from all loss,
investigation, suits, damage, cost, expense (including attorneys’ fees), liability or claims
for personal injury or property damage incurred or occurring in, on or about the
Property.
b. Indemnification Survives Termination: All representations and warranties of the parties
contained herein shall survive the termination of this Agreement. All provisions of this
Agreement that require Owner to have insured or to defend, reimburse or indemnify
Broker shall survive any termination. If Broker becomes involved in any proceeding or
litigation by reason of having been Owner's Broker, such provisions shall apply as if this
Agreement were still in effect.
11. Termination
a. Early Termination: This Agreement may be terminated by either party at any time upon
14 days notice.
b. Termination for Violation of Agreement or Law: Broker reserves the right to terminate
this Agreement upon 14 days written notice if Owner breaches this Agreement. Broker
reserves the right to terminate this Agreement immediately if Owner is found in
violation of any federal, state or local law, or which could create a liability for Broker or
prove harmful to Broker’s goodwill and reputation, or otherwise endanger Broker in any
way.
c. Owner Responsible for Payments: Upon termination, Owner shall pay Broker any fees,
commissions, and expenses which are already due to Broker, but no termination fee shall
be charged.
12. Rights Cumulative; No Waiver: The exercise of any right or remedy provided in this
Agreement shall not be an election of remedies, and each right and remedy shall be cumulative.
The failure of either party to this Agreement to insist at any time upon the strict observance or
performance of any of the provisions of this Agreement, or to exercise any right or remedy
provided in this Agreement, shall not be construed as a waiver of such right or remedy with
respect to subsequent defaults. Every right and remedy provided in this Agreement may be
exercised from time to time and as often as may be deemed expedient by the party exercising
such right or remedy.
13. Applicable Law and Partial Invalidity: The interpretation of this Agreement shall be governed
by the laws of the State of Minnesota. Any action arising under this Agreement shall be brought
in district court in Hennepin County, Minnesota.
Owner Initials ________
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14. Complete Agreement: This Agreement shall be binding upon the parties, and each of their
respective heirs, executors, administrators, successors and assigns. There are no warranties or
representations not herein contained. Terms of this Agreement are incorporated if not rejected.
This Agreement may be amended at any time by Broker with written notice given to Owner
within a reasonable time.
OWNER:
OWNER:
By ______________________________
Owner Signature
By________________________________
Owner Signature
By ______________________________
Owner Name (print please)
By________________________________
Owner Name (print please)
Date ____________________________
Date ______________________________
BROKER:
By ______________________________
Authorized Agent for Broker
By ______________________________
Agent (print please)
Date ____________________________
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EXHIBIT A
PROPERTY INFORMATION
Owner: ______________________________Ph #:________- _________-________
Owner: ______________________________Ph #:________- _________-________
Company or LLC Name: ___________________________________________________
Email Address:________________________________@____________________.COM
Owner Mailing Address: ________________________________________________
Rental Property Address:
____________
# of Bedrooms:_________ # of Bathrooms: __________ # of Garages: ______________
Year Built: _____________ (Prior to 1978 - Lead Based Paint Addendum Req’d.)
Square Footage: _____________ Fireplace: ___________ Mailbox #: ______________
Water: (T or O) Provider:________________ Avg. Monthly $:____________________
Electric: (T or O) Provider: ______________ Avg. Monthly $: ___________________
Gas: (T or O) Provider: ________________ Avg. Monthly $:_____________________
Trash: (T or O) Provider:________________ Avg. Monthly $ : ____________________
Pool (yes or no)
Air Conditioning (yes or no)
Pool Maintenance: (T or O )
HOA Dues: $___________ Who Pays: (T or O ) Name of HOA: ___________________
HOA Contact Person: _______________________ Ph # _______- ________-________
What is Included in Association Dues?:________________________________________
When is the Property Available for Move in?: ________/__________/____________
Pets Allowed: ( yes or no )
Deposit Amount: $ __________________________
Smoking Allowed: ( yes or no)
Deposit Amount: $ __________________________
Property Identification Number:
County: ________________
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Do you have a maintenance protection plan? I.E. Center Point or Xcel or Home Warranty? ( Y or N )
Name of Company: ____________________________
Acct # ______________________________________
Contact #: ___________________________________ Is this 24 hours: ( Yes or No )
Maintenance protection plan covers: __________________________________________
Lockbox Code: _____________
Key: ( yes or no ) Garage Code:
Agreed Upon Rental Range: Low:____________________ High:___________________
Specific Vendors: Any vendors you wish to have Renters Warehouse specifically use?
Name: _________________________________________________________________
Trade/ Profession: ________________________________________________________
Phone Number: __________________________________________________________
Email: __________________________________________________________________
Emergency Contact Info:
Name: __________________________________________________________________
Phone: _________________________________________________________________
Email: __________________________________________________________________
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EXHIBIT B
AGENCY RELATIONSHIPS IN REAL ESTATE TRANSACTIONS
(Minnesota Law now requires you sign an agency disclosure)
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EXHIBIT C
TENANT WARRANTY
This Tenant Warranty (“Warranty”) shall begin on the date Tenant takes occupancy of the Property
and shall terminate 180 days after said date.
*This Warranty period may be extended to 270 days in duration if Owner engages the services of Broker
as a property manager, by executing a separate Property Management Agreement with Broker.
Tenant(s): ____________________________________Occupancy date:
If Owner has evicted Tenant or Tenant has defaulted or terminated the Agreement and as a result,
the Property must be leased to a new Tenant within 180-270 days after occupancy begins with the
initial Tenant under the Tenant Placement Agreement, Owner may request Warranty coverage from
Broker. To request coverage, Owner must submit a written notice mailed by certified mail to
Broker at the following address:
Hayden & Co., LLC, d/b/a Renters Warehouse
6101 Baker Rd, Suite 200
Minnetonka, Minnesota 55345
Warranty coverage: This Warranty provides Owner with the benefit of Broker offering the Tenant
Placement services outlined in the Tenant Placement Agreement at no charge and to find a
replacement Tenant for the specific property or unit covered by the Agreement. This Warranty is
not applicable for any other property owned by Owner. If, during the Warranty coverage period,
Owner or another company procures a replacement tenant, or Owner retakes possession of the
property, the Warranty is deemed satisfied. Broker’s Warranty coverage is limited to efforts by
Broker to find a replacement tenant, and Broker bears no responsibility for any commission, fee, or
payment due from Owner to any other broker or company engaged by Owner.
Once a replacement Tenant has been procured, the Warranty coverage shall be deemed satisfied and
terminated, with no further or repeat coverage available. This Warranty is non-transferrable, nonassignable, and expires within 180-270* days after the initial Tenant is procured by Broker. This
Warranty has no independent value nor may it be sold or redeemed for cash. Broker shall not be
liable for any past rent, late fees, damages, any court fees, legal expenses, or unpaid utilities as a
result of tenant placement or tenant default. Broker makes no additional warranties or promises,
whether implied or otherwise. Broker must approve tenant, prior to lease execution, for this
Warranty to be valid. Broker has sole and unilateral authority to determine whether tenant
“qualifies” for Owner to obtain this warranty coverage, based on Tenant’s background check, credit
history, previous rental history, employment, or income verification and similar considerations.
Tenant Approved by Broker for purposes of Warranty coverage:
_____________________________
Owner Signature
Date
Yes
No
________________________________
Agent For Broker
Date
12
W-9
Form
(Rev. December 2011)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶
Other (see instructions) ▶
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
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 the “Name” line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
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).
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 on page 4.
Sign
Here
Signature of
U.S. person ▶
Date ▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
Note. If a requester gives you a form other than Form W-9 to request
your TIN, you must use the requester’s form if it is substantially similar
to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 12-2011)