2. Address 1
4. Address 2
6. City
7. State
8. Zip
10. Phone
11. Fax
13. Email
15. Website
17. Notice
    Due to IRS regulations, we are required to have a W-9 form on file.
    
    If you have not already, please fill out and send the completed and signed form to:
    Washington County Controller's Office
    100 W. Beau St., Suite 403
    Washington, PA 15301
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field