1099 Request Form
PAYER NAME _______________________________________ TITLE _____________________________
PHONE___________________________
ADDRESS __________________________________________________________
CITY_______________________ STATE _____
ZIP ___________
EMPLOYER ID # ____________________________________________________
Please prepare ______ 1099s for the following individuals:
1. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
2. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
3. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ ____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
4. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
5. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _________________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
6. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
7. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
8. NAME ________________________________________________ SS# _____________________________________
AMOUNT $ _____________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
9. NAME ________________________________________________ SS# _____________________________________
AMOUNT_______________
ADDRESS ______________________________________________ CITY ___________________________________ ST ______
ZIP __________________
DESCRIPTION OF PAYMENT
If you need to add more names, please make copies of this form. Totals of 1099s $ ____________
Fax this to our office, no later than January 20 to meet deadlines. Additional fees may apply to requests received after January 20.
718-998-3156
Please keep in mind the penalties for failure to issue 1099 forms can be deep and are strictly enforced.