Individual – Contrato

1Data for the agreement

2ACH Authorization

3Form W-9

Welcome to AgguaSystems' electronic signature system, our system will guide you to sign your agreement. The process is quite simple, just follow the steps and in less than 5 minutes your agreement will be ready and you will be part of our company as an Independent Sales Executive.

What am I signing? Please read the agreement before signing it, access it by clicking here.

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Date *

Initials *

Escribe tus iniciales

Full name *

Nombre

Apellidos

Confirm your identity

UPLOAD 2 FORMS OF IDENTIFICATION. ACCEPTABLE FORMS INCLUDE:
DRIVER'S LICENSE - PASSPORT - BIRTH CERTIFICATE - SOCIAL SECURITY CARD.

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Upload identification form 1 *

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

Upload identification form 2: *

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

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Enter your driver's license number *

Signature *

Please use the entire signature box, if you don't like your signature you can delete it by clicking on the X at the top right.

Province of issuance *

Check box *

I acknowledge that I have read, understand and agree to comply with the statements made above in this acknowledgment of rights and responsibilities. I understand that failure to comply with any part of these statements may result in suspension, termination and personal liability of the Independent Contractor related to such statement.

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):

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Exempt payee code (if any)

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

Exemption from FATCA reporting code (if any)

5. Address (City, Estate, Zip code)

Requester’s name and address (optional)

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Requester's name

1.Requester's address

Number, Street, and Apt. or Suite No.

1.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.

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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.

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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.

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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.

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Signature

Date

Confirm your identity

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)

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Social security number

Employer identification number

Part II - Certification