New Client Account Application

    Step 1/3. Client Application

    Download Client Application   | Upload Client Application File.  


    Terms Requested: Pre PaymentNet 30      


    Disclaimer:

    By Submitting this form electronically or affixing a signature below, the undersigned (if a Corporation, the Corporate authorized Officers/Agents) agree to the following:

    1. That the information contained within this document is warranted to be true and correct.
    2. To pay when due, all invoices from BlackHawk Data LLC, ("BlackHawk") in accordance with the Standard Terms and Conditions. If no terms are given invoice payment will be due Net 30 from date
    3. In the event of default of payment when due, all costs of collection, including Attorneys' Fees and Court Costs, shall be paid by the applicant.

    Step 2/3: W-9

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    Individual/sole proprietorC corporationS corporationPartnershipTrust/estateLLCOther



    Exempt payee code (if any)

    Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code


    Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

    Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

    or


    Under penalties of perjury, I certify that:
    1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

    2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

    3. I am a U.S. citizen or other U.S. person (defined below); and

    4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

    Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
    other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

    Step 3/3: Master Services Agreement

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    This Master Services Agreement (“Agreement”) by and between (“Client”) located at and BlackHawk Data LLC (“BlackHawk”) located at 505 8th Avenue, Suite 12A-03, New York, NY 10018, is effective as of the date specified below (the “Effective Date”).

    BlackHawk Data LLC



    Signature: