HomeMy WebLinkAboutV8 FORM FOR COMMISSIONERS revised 11-2017 Fillable (MASTER) 04.08.21Form #: V-8 Vendor Number Assigned
w11/17 Date/Initials
Vendor Code
Finance Dept. Use Only
Request for Information to Establish Vendor File
To establish a vendor file with the County of Hawaii, certain information is required. This information is necessary so that we can report payments to the Internal Revenue Service on Form 1099 if they fall under the IRS information reporting requirements. If you do not provide us with the information requested below, we may have to impose backup withholding of 28% on any payments we make to you. Additional penalties are:
Failure to Furnish TIN: If you fail to furnish your correct TIN to a requestor, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False Information with Respect to Withholding: If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Thank you for your cooperation in completing this form and returning it to:
DEPT. PLANNING
ADDRESS 101 PAUAHI ST, SUITE 3 REQUESTOR NAME: CLAUDIA LATO
Ph: 961-8128 Fax: 961-8742
COMPANY NAME:
INDIVIDUAL NAME (If not corporation)
Correspondence/Order Address: PAYMENT NAME and address:
Name:
Address:
City/State/Zip:
Telephone: Fax: Email:
DO NOT ALTER – DO NOT REMOVE OR ADD
Type of organization: X Individual/sole proprietor or single-member LLCC-Corporation Partnership S-Corporation Trust/estate
Limited Liability Company C = Corporation S = Corporation P = Partnership
Federal ID Number (SSN or FEIN):
State of Hawaii ID Number (GET):
Will be providing: Services Both goods and services Tangible Goods Refunds (Type O) Rental, Licensed Agent for owner X Others = Board of Appeals Commissioner Rental, Agent for Owner (M-1) County Employee Rental of own property
Print name:
Signature Required: Date: