Name * Use your full legal name. First Name Last Name Date of Birth * MM DD YYYY Business Name * If not applicable, write N/A. If providing an EIN, this must be the business associated. Address * P.O. Boxes are not permitted. Address 1 Address 2 City State/Province Zip/Postal Code Country Are you providing an SSN or EIN? * SSN EIN SSN or EIN * If an SSN is used, the 1099 MISC form will be addressed to you. If an EIN is used, the 1099 MISC form will be addressed to your company. Thank you!