Contractor PII Form

To comply with identification and reporting requirements, we require your personal information. Please note that while no tax will be withheld from your payment, all payments are reported to U.S. tax authorities. Payment cannot be processed until Lone Mountain Global receives this completed form with your personal details. Kindly ensure all fields below are filled out.

Contract Reference *See contract item D.

Full Name *

E-mail Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Date of Birth

Tax Country *

SSN / TN / PN *Social security number (SSN), Tax Identification number (TN), or Passport number and citizenship (PN)

Provided above is: *Social Security numberTax Identification numberPassport number

Contractor PII Form

Your Name *

Your Email *

Your message

Your Name *

Your Email *

Your message

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