<p> NEW SUPPLIER REQUEST FORM Please fill out this electronic document and email to [email protected] *FireEye Requestor*: Click here to enter text. *SUPPLIER INFORMATION Business Name: Click here to enter text. Years in Business: Click here to enter text. DBA/Alias/Alternate Name: Click here to enter text. Business Address: Click here to enter text. City/State: Click here to enter text. Zip Code: Click here to enter text. Primary Contact: Click here to enter text. Contact Email: Click here to enter text. Contact Phone: Click here to enter text. Contact Position: Click here to enter text.</p><p>*REMIT TO: (Where payment will be sent, if different from above) Remit-To Address: Click here to enter text. City/State: Click here to enter text. Zip Code: Click here to enter text. A/R Contact: A/R Email: Payment Terms: Choose an item. If other, specify: Click here to enter text. Payment Method: Choose an item. If other, specify: Click here to enter text. Invoice Currency: Click here to enter text.</p><p>*BUSINESS DETAILS Organization Type: Choose an item. If other, specify: Click here to enter text. Business Description: Click here to enter text. Product/Service Classification Type: Choose an P/S Code: Click here to enter item. text. *ADDITIONAL DETAILS FOR US COMPANIES TAX Id- type: Choose an item. TAX Id #: Click here to enter text. Are you exempt from backup withholding? ☐Yes ☐No *Are you a 1099-MISC recipient? ☐Yes ☐No *Federal Income Tax Law requires a Form 1099 Information Return with a valid Taxpayer Identification Number to be filed for certain payments over $600.00 made in the course of conducting a trade or business. Furthermore, these payments may be subject to Backup Federal Income Tax Withholding for all payees who have not submitted a valid Federal Tax Identification Number at the time of payment. *California Franchise Tax Board requires 7% Withholding tax form distributions of California source income provided to Domestic Non-Resident contractors Please check off appropriate box that permits to Non-Resident Contractor CA withholding: ☐Yes, withhold CA Tax from my California source income ☐No, Do not withhold taxes (Please provide a copy of approved Waiver form Are you a Minority or Women-owned Business?: ☐Yes ☐No *If yes select below Classification: Choose an item. Minority Type: Choose an item. Certified By: Click here to enter text. Expiration Date: Click here to enter text. *ADDITIONAL DETAILS FOR NON-US COMPANIES TAX Id- type: Choose an If other, specify: Click here TAX Id #: Click here to item. to enter text. enter text. Non-US Entity: Are you providing services to FireEye US & are you operating in the US? ☐Yes ☐No If yes, please provide IRS Form W-8BEN, W-8EXP, or W-8ECI (available at IRS.gov) If no, please provide other form of identification, such as a business license or tax id certificate</p><p>PAYMENT/FINANCIAL INSTITUTION INFORMATION Bank Name: Click here to enter text. Intermediary Bank (if applicable): Click here to enter text. Bank Address: Click here to enter text. City/State: Click here to enter text. Zip Code: Click here to enter text. Bank Account Number: Click here to enter text. IBAN Account Number (For EU): Click here to enter text. Bank Transit (ABA/Routing/CHIPS#-For US): Click here to enter text. Bank Account Type: ☐ Checking ☐ Savings ☐ Other For International Use: Bank Code Type: Choose an item. Enter Bank Code: Click here to enter text.</p><p>CERTIFICATION AND REQUIRED SIGNATURE 1. I hereby certify under penalty of perjury that the information provided is true and correct. The number shown on this form is my correct Taxpayer Identification Number, and 2. I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am not subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am not subject to backup withholding. Electronic Signature: (Double click to sign)</p><p>FIREEYE INTERNAL W9 Received: ☐Yes ☐No Background check: ☐Yes ☐No MSA Signed: ☐Yes ☐No Insurance: ☐Yes ☐No NDA: ☐Yes ☐No Security Assessment ☐Yes ☐No ☐N/A</p><p>For your knowledge: FireEye Inc. SVB Wire Requirements UK Australia APAC India Mexico/Latin America Account X X X X X IBAN X X Sort code X X Swift Code X X BSB X Phone # X X IFSC X Tax ID X X CLABE X</p>