1.) Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2.) Business name/disregard 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.

Choose 1

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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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

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

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Signature Certificate

Document name: Test

Unique Document ID: 656d6a67bac6a4d41dfc89ab0a62ba770487419f

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Timestamp	Audit
November 13, 2024 11:56 am PST	Test Uploaded by Alex Rojas - alex@gtdigital.info IP 73.189.71.69

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Audit Trail Serial# 60efc1fc1e0e6b0d0e0be985f7ee75d7