Individuo Español

1Datos para el acuerdo

2Autorización ACH

3Forma W-9

Bienvenido al sistema de firma electrónica de AgguaSystems, nuestro sistema te guiará para firmar tu acuerdo. El proceso es muy sencillo, sólo tienes que seguir los pasos y en menos de 5 minutos tu acuerdo estará listo y formarás parte de nuestra empresa como Ejecutivo de Ventas Independiente.

¿Qué estoy firmando? Por favor, lea el acuerdo antes de firmarlo, acceda a él haciendo clic aquí.

Layout

Fecha *

Inicales *

Escribe tus iniciales

Nombre completo *

Nombre

Apellidos

Confirme su identidad

Sube 2 formas de identificación. Las formas aceptables incluyen:
Licencia de conducir - Pasaporte - Certificado de nacimiento - Tarjeta de seguro Social

Layout

Subir formulario de identificación 1: *

Haz clic o arrastra un archivo a este área para subirlo.

Subir formulario de identificación 2: *

Haz clic o arrastra un archivo a este área para subirlo.

Layout

Ingrese su numero de licencia de conducir *

Firma *

Por favor utiliza todo el recuadro para firmar, si tu firma no te gusta la puedes borrar haciendo clic en la X arriba ala derecha.

Estado de emisión *

Casilla de verificación *

Reconozco que he leído, entiendo y acepto cumplir con las declaraciones hechas arriba en este reconocimiento de derechos y responsabilidades. Entiendo que el incumplimiento de una parte de estas declaraciones puede resultar en la suspensión, terminación y responsabilidad personal del Contratista Independiente relacionada con dicha declaración.

Request for Taxpayer Identification Number and Certification

Go to www.irs.gov/FormW9 for instructions and the latest information.

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..

If you selected "Limited liability company", enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Layout

Exempt payee code (if any)

5. Address (Number, Street, and Apt. or Suite No.)

Exemption from FATCA reporting code (if any)

Address (City, Estate, Zip code)

Requester’s name and address (optional)

Layout

Requester's name

Requester's address

Number, Street, and Apt. or Suite No.

Requester's address

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 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

Then enter the digits specified in each field, as if you were filling the W9 on paper,as shown in the picture.

Layout

Enter first 3 digits

Enter the next 2 digits

Enter last 4 digits

Employer identification number

Then enter the digits specified in each field, as if you were filling the W9 on paper, as shown in the picture.

Layout

Enter first 2 digits

Enter last 7 digits

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.

Layout

Signature

Date

Confirme su identidad

Sube 2 formas de identificación. Las formas aceptables incluyen: Licencia de conducir - Pasaporte - Certificado de nacimiento - Tarjeta de seguro Social

Request for Taxpayer Identification Number and Certification

4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Requester’s name and address (optional)

Part I - Taxpayer Identification Number (TIN)

.

Social security number

Employer identification number

Part II - Certification

Sube 2 formas de identificación. Las formas aceptables incluyen:
Licencia de conducir - Pasaporte - Certificado de nacimiento - Tarjeta de seguro Social