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.

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