OSI - O’ShaughnaHill Surety & Insurance, Inc

W-9

Name (as shown on your income tax return)
First Last
Business Name/Disregarded Entity Name

(If different from above)
Federal Tax Classification
- Individual/Sole Proprietor
- C Corporation
- S Corporation
- Partnership
- Trust/Estate
- Limited Liability Company
Address
Street Address City State / Province / Region ZIP / Postal Code
Date
MM slash DD slash YYYY
Signature