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For AP: This page is a W-9 worksheet with public vendor fields. The taxpayer identification number (SSN/EIN) is not published on the website. Request a signed Form W-9 with TIN by email:

Email signed W-9

IRS Form W-9 worksheet

Request for Taxpayer Identification Number

Substitute worksheet for Physician Forge. Prefer the official signed PDF for your permanent vendor file.

1 Name (as shown on your tax return)

Andrew Albert

2 Business name / disregarded entity name (DBA)

Physician Forge

3 Federal tax classification

Individual / sole proprietor

5 Address

2152 Winston View Drive NE
Cedar Springs, MI 49319

Part I — Taxpayer Identification Number (TIN)

TIN provided on the signed Form W-9 only (not published online). Emaildrewalbert7@gmail.com.

Part II — Certification

Under penalties of perjury, I certify that the TIN below (on the signed copy) is correct, that I am a U.S. person, and that I am not subject to backup withholding unless noted on the signed form.

Signature (signed copy by email) · Date

Andrew Albert · +1 (517) 213-1002

Not legal or tax advice. Hospitals should keep the signed IRS Form W-9 in their vendor master file.