Sign up for Business Connections

Step 1 of 4 - W-9 and Information

Please enter the name of the individual OR the name of the company and contact person to whom the referral reward should be sent or bill credit should be applied, along with the Tax Payer Identification Number; this should be your Social Security Number (SSN) or Employer Identification Number (EIN).

Bold = required fields

Individual
First Name:
Last Name:
Social Security Number (SSN): (Please do not use dashes)
Confirm Social Security Number:
OR Company
Company Name:
Contact First Name:
Contact Last Name:
Employer Identification Number (EIN):
Confirm Employer Identification Number:
Contact Information
Address Line 1:
Address Line 2:
City:
State:	Alabama, US Alaska, US Arizona, US Arkansas, US California, US Colorado, US Connecticut, US Delaware, US District of Columbia, US Florida, US Georgia, US Hawaii, US Idaho, US Illinois, US Indiana, US Iowa, US Kansas, US Kentucky, US Louisiana, US Maine, US Maryland, US Massachusetts, US Michigan, US Minnesota, US Mississippi, US Missouri, US Montana, US Nebraska, US Nevada, US New Hampshire, US New Jersey, US New Mexico, US New York, US North Carolina, US North Dakota, US Ohio, US Oklahoma, US Oregon, US Pennsylvania, US Rhode Island, US South Carolina, US South Dakota, US Tennessee, US Texas, US Utah, US Vermont, US Virginia, US Washington, US West Virginia, US Wisconsin, US Wyoming, US
Zip/Postal Code:
Primary Phone:	Ext:
Cell Phone:
Email Address:
Fax:
XO Sales Representative Market:	*** Select Market *** Atlanta Austin BUFFALO Boston CENTRAL Carrier Emerging East Carrier Emerging West Carrier Strategic East Carrier Strategic West Carrier Vertical East Carrier Vertical West Carrier West Carrier Wholesale Charlotte Chicago Chicago SMB Cleveland Columbus DC / Maryland / VA Dallas Denver Detroit FEDERAL Fort Lauderdale Houston LA Downtown LA Orange County Las Vegas Memphis Miami Minneapolis NATL AND STRATEGIC - CENTRAL NATL AND STRATEGIC - EAST NATL AND STRATEGIC - WEST NORTHEAST NY Sme NYC Nashville Orlando Philadelphia / Central PA Phoenix Pittsburgh Portland ROCHESTER SOUTHEAST SYSTEM INTEGRATORS Sacramento Salt Lake City San Antonio San Diego San Francisco San Jose Seattle Spokane St. Louis Tampa WEST
XO Sales Representative:
I give XO permission to send me information regarding their products and services in the future.	Yes No
Are you an XO employee ?	Yes No

Under penalties of perjury, I certify that the number shown on this form is my correct taxpayer identification number. All submissions are treated in accordance with the XO Privacy Policy.