Form SS-4 Application for Employer Identification Number

EIN (Rev. January 2009) (For use by employers, corporations, partnerships, trusts, estates, churches,

government agencies, Indian tribal entities, certain individuals, and others.)

OMB No. 1545-0003

Department of the Treasury

Internal Revenue Service

1 Legal name of entity (or individual) for whom the EIN is being requested

2 Trade name of business (if different from name on line 1) 3 Executor, administrator, trustee, “care of” name

4a Mailing address (room, apt., suite no. and street, or P.O. box) 5a Street address (if different) (Do not enter a P.O. box.)

4b City, state, and ZIP code (if foreign, see instructions) 5b City, state, and ZIP code (if foreign, see instructions)

6 County and state where principal business is located

7a Name of principal officer, general partner, grantor, owner, or trustor

Estate (SSN of decedent)

9a Type of entity (check only one box). Caution. If 8a is “Yes,” see the instructions for the correct box to check.

Partnership Plan administrator (TIN)

Sole proprietor (SSN)

Farmers’ cooperative

Corporation (enter form number to be filed) ©

Personal service corporation

REMIC

Church or church-controlled organization

National Guard

Trust (TIN of grantor)

Group Exemption Number (GEN) if any ©

Other nonprofit organization (specify) ©

Other (specify) ©

9b If a corporation, name the state or foreign country

(if applicable) where incorporated

Changed type of organization (specify new type) ©

10 Reason for applying (check only one box)

Purchased going business

Started new business (specify type) ©

Hired employees (Check the box and see line 13.) Created a trust (specify type) ©

Created a pension plan (specify type) ©

Banking purpose (specify purpose) ©

Other (specify) ©

11 Date business started or acquired (month, day, year). See instructions. 12 Closing month of accounting year

15 First date wages or annuities were paid (month, day, year). Note. If applicant is a withholding agent, enter date income will first be paid to

nonresident alien (month, day, year) ©

Agricultural Household

13 Highest number of employees expected in the next 12 months (enter -0- if none).

17 Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.

18 Has the applicant entity shown on line 1 ever applied for and received an EIN? Yes No

Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.

Designee’s telephone number (include area code)

Signature © Date ©

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form SS-4 (Rev. 1-2009) Type or print clearly.Cat. No. 16055N

State Foreign country

Designee’s fax number (include area code)

© See separate instructions for each line.

( )

( )

© Keep a copy for your records.

Compliance with IRS withholding regulations

7b SSN, ITIN, or EIN

Other

Applicant’s telephone number (include area code)

Applicant’s fax number (include area code)

( )

( )

Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.

Name and title (type or print clearly) ©

Third

Party

Designee

Designee’s name

Address and ZIP code

Federal government/military

Indian tribal governments/enterprises

State/local government

Do you expect your employment tax liability to be $1,000

or less in a full calendar year? Yes No (If you

expect to pay $4,000 or less in total wages in a full

calendar year, you can mark “Yes.”)

Is this application for a limited liability company (LLC) (or 

a foreign equivalent)? Yes No

8a If 8a is “Yes,” enter the number of

LLC members ©

8b

8c If 8a is “Yes,” was the LLC organized in the United States? Yes No

14

16 Check one box that best describes the principal activity of your business.

Construction

Real estate

Rental & leasing

Manufacturing

Transportation & warehousing

Finance & insurance

Health care & social assistance

Accommodation & food service

Other (specify)

Wholesale-agent/broker

Wholesale-other Retail

If “Yes,” write previous EIN here ©
Do I Need an EIN?

File Form SS-4 if the applicant entity does not already have an EIN but is required to show an EIN on any return, statement,

or other document.1 See also the separate instructions for each line on Form SS-4.

IF the applicant... AND... THEN...

Started a new business

Hired (or will hire) employees,

including household employees

Opened a bank account

Changed type of organization

Purchased a going business 3

Created a trust

Created a pension plan as a

plan administrator 5

Is a foreign person needing an

EIN to comply with IRS

withholding regulations

Is administering an estate

Is a withholding agent for

taxes on non-wage income

paid to an alien (i.e.,

individual, corporation, or

partnership, etc.)

Is a state or local agency

Is a single-member LLC

Is an S corporation

Does not currently have (nor expect to have)

employees

Does not already have an EIN

Needs an EIN for banking purposes only

Either the legal character of the organization or its

ownership changed (for example, you incorporate a

sole proprietorship or form a partnership) 2

Does not already have an EIN

The trust is other than a grantor trust or an IRA

trust 4

Needs an EIN for reporting purposes

Needs an EIN to complete a Form W-8 (other than

Form W-8ECI), avoid withholding on portfolio assets,

or claim tax treaty benefits 6

Needs an EIN to report estate income on Form 1041

Is an agent, broker, fiduciary, manager, tenant, or

spouse who is required to file Form 1042, Annual

Withholding Tax Return for U.S. Source Income of

Foreign Persons

Serves as a tax reporting agent for public assistance

recipients under Rev. Proc. 80-4, 1980-1 C.B. 581 7

Needs an EIN to file Form 8832, Classification

Election, for filing employment tax returns and

excise tax returns, or for state reporting purposes 8

Needs an EIN to file Form 2553, Election by a Small

Business Corporation 9

Complete lines 1, 2, 4a–8a, 8b–c (if applicable), 9a,

9b (if applicable), and 10–14 and 16–18.

Complete lines 1, 2, 4a–6, 7a–b (if applicable), 8a,

8b–c (if applicable), 9a, 9b (if applicable), 10–18.

Complete lines 1–5b, 7a–b (if applicable), 8a, 8b–c

(if applicable), 9a, 9b (if applicable), 10, and 18.

Complete lines 1–18 (as applicable).

Complete lines 1–18 (as applicable).

Complete lines 1–6, 9a, 10–12, 13–17 (if applicable),

and 18.

Complete lines 1–5b, 7a–b (SSN or ITIN optional),

8a, 8b–c (if applicable), 9a, 9b (if applicable), 10,

and 18.

Complete lines 1, 3, 4a–5b, 9a, 10, and 18.

Complete lines 1, 2, 3 (if applicable), 4a–5b, 7a–b (if

applicable), 8a, 8b–c (if applicable), 9a, 9b (if

applicable), 10, and 18.

Complete lines 1, 2, 4a–5b, 9a, 10, and 18.

Complete lines 1–18 (as applicable).

Complete lines 1–18 (as applicable).

3 Do not use the EIN of the prior business unless you became the “owner” of a corporation by acquiring its stock.

4 However, grantor trusts that do not file using Optional Method 1 and IRA trusts that are required to file Form 990-T, Exempt Organization Business Income Tax

Return, must have an EIN. For more information on grantor trusts, see the Instructions for Form 1041.

5 A plan administrator is the person or group of persons specified as the administrator by the instrument under which the plan is operated.

6 Entities applying to be a Qualified Intermediary (QI) need a QI-EIN even if they already have an EIN. See Rev. Proc. 2000-12.

7 See also Household employer on page 4 of the instructions. Note. State or local agencies may need an EIN for other reasons, for example, hired employees.

8 See Disregarded entities on page 4 of the instructions for details on completing Form SS-4 for an LLC.

9 An existing corporation that is electing or revoking S corporation status should use its previously-assigned EIN.

Complete lines 1–18 (as applicable).

Form SS-4 (Rev. 1-2009) Page 2

1 For example, a sole proprietorship or self-employed farmer who establishes a qualified retirement plan, or is required to file excise, employment, alcohol,

tobacco, or firearms returns, must have an EIN. A partnership, corporation, REMIC (real estate mortgage investment conduit), nonprofit organization

(church, club, etc.), or farmers’ cooperative must use an EIN for any tax-related purpose even if the entity does not have employees.

2 However, do not apply for a new EIN if the existing entity only (a) changed its business name, (b) elected on Form 8832 to change the way it is taxed (or is

covered by the default rules), or (c) terminated its partnership status because at least 50% of the total interests in partnership capital and profits were sold or

exchanged within a 12-month period. The EIN of the terminated partnership should continue to be used. See Regulations section 301.6109-1(d)(2)(iii).