Congressman Rick Larsen 8/7/2023

Instructions for Completing U.S. House of Representatives Substitute W-9 and ACH Vendor/Miscellaneous Payment Enrollment Form Section I -Agency Information—Includes the name and address, agency identifier, agency location code and telephone number for the House of Representatives. Section II -Payee/Company Information —Print or type the name of the payee/company and address that will receive payment, social security or taxpayer ID number, contact person name, telephone number and email of the payee/company. Print or type the purchase order and remit to addresses if different from the payee/company address. Check the appropriate boxes for federal tax classification. Section III -Financial Institution Information —Print or type the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor(payee/company) account title and account number. Check the appropriate box for type of account. Payee/Company may include a voided check with this form. ACH Account Information Located on a Check or Deposit Ticket FINANCIAL INSTITUTION NAME name of the financial institution to which the payments are to be directed ROUTING TRANSIT NUMBER(RTN) financial institution's 9 digit routing transit number; found on the bottom of a check or deposit ticket or from your Financial Institution ACCOUNT TITLE employee's or vendor's name on the account ACCOUNT NUMBER account number at the financial institution 1. Routing Transit Number(RTN) —nine digits located between THOMAS 9.ANDERSON 101 two symbols. This number t? F ASA t vFiEtt AYiE ,f, 127 identifies the bank holding your G-iG account and check processing center. 2. Account number—this is your complete account number. Your account number can be up to 17 digits. Please include u ALAP Evt;� leading zeros. #i ATC4st014 Want Sank 3. ACH Routing Transit Number— Automated Clearing House routing number, use this 1=00000001: L 2 3 L.5 6 78 9Ov 001 D number for your Routing Transit Number(RTN)if you a w_ Si* ,M uA .. ' bank with SunTrust Bank. 4. Check number—This 1 2 3 4 information is not necessary- do not provide Section IV-Socio-Economic Information—Check the boxes for each category, if applicable:type of business, small disadvantaged business program, HUBZone program, emerging small business, women-owned business, other preference programs,Veteran owned status and size of business. Detailed information related to Small Business programs can be found at http://www.sba.gov/. Section V-Certification of Data By Payee/Company—Print or type the name, title/position and phone number of the Authorized official. The Authorized official must sign and date the form.