W-9 Upload

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  • Internet browser’s Pop-up blocker must be disabled for http://www.synergyinsurance.net
  • Include a Provider Contact Email that allows incoming messages; a valid reply-to email is required for validation
  • Use this form for one individual claimant, with a maximum of five attachments
  • Files cannot exceed 2GB; Accepted file types: PDF, JPG, BMP, Word, Excel