Supporting the Success of Individual Physicians, Practices, and Communities.

W9 Forms & Faxback Forms

W9 Form

Please download the W9 form here, or visit http://www.irs.gov/pub/irs-pdf/fw9.pdf and fax it to GLVIPA with the faxback sheet below.

Faxback Sheet

Please use this faxback sheet when submitting the above W9 form via fax.