Facebook Credits

Sign Up Your Company for Facebook Credits

1. Company Information

Company Name Company Type

Required Individual (Sole Proprietor)

Company Address

Street 1: Required Country: Select a country

Street 2: Optional State: Select a state

City: Required Zip: Required

Company Contact Information

Email: Required Phone: Required

TIN: Required Type Fax: Optional

2. Business Owner Information

Business Owner Name

First Name: Required Last Name: Required

Middle Name: Optional

Business Owner Address

Street 1: Required Country: Select a country

Street 2: Optional State: Select a state

City: Required Zip: Required

3. Bank Information

Bank Name Bank Branch Country of Bank

Required Required Select a country

Account Details

Routing Number: Required for US banks Account Number: Required for US banks

4. Disclaimers

I hereby authorize Facebook to provide direct deposit of any payments due in the above designated bank information

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.

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