WP E-Signature by Approve Me - Sign Documents Using WordPress -

W9 Upload Form

Medication Discount Card LLC DBA RxGo
8547 E Arapahoe Rd. Ste 513 Greenwood Village, CO 80112
(609) 961-1114

Please upload a scan or picture of your W9. If you do not have the form you may download it at https://www.irs.gov/pub/irs-pdf/fw9.pdf.

I confirm the attached file is my W9

Partner's Signature

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

02/26/2021 8:34 AM EDT

W9 Upload Form Uploaded by Jeremy Duboys - rxgodiscounts@gmail.com IP 65.112.196.138