W-9 Information 1. Name of Individual or Entity * 2. Business Name / Disregarded Entity Name 3a. Federal Tax Classification * 4. Exempt Payee Code 4. FATCA Exemption Code 5. Street Address * Apartment / Suite / Unit 6. City * State * ZIP Code * 7. Account Number(s)

Part I — Taxpayer Identification Number TIN Type * Taxpayer Identification Number * This field must be encrypted and securely stored by the website backend. It must never be included in ordinary email notifications.

Part II — Certification

Under penalties of perjury, I certify that the taxpayer identification number provided is correct or I am waiting for a number to be issued; that I am not subject to backup withholding unless otherwise indicated; that I am a U.S. citizen or other U.S. person; and that any FATCA exemption code entered is correct.

Have you been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest and dividends? * I certify under penalties of perjury that the information provided is true and correct and that I am authorized to submit this Form W-9. * Electronic Signature — Type Full Legal Name * Title / Capacity Date *

Form W-9 Submission