HomeMy WebLinkAboutV8 FORM revised 11-2017 (non profit)Form #: V-8 Vendor Number Assigned _____________
11/17 Date/Initials ___________________
Vendor Code ___________________
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.
DEPT.
ADDRESS
REQUESTOR NAME:
Ph:Fax:
COMPANY NAME:
INDIVIDUAL NAME
(If not corporation)
Correspondence/Order Address:
Name:
Address:
City/State/Zip:
Telephone:Fax:Email:
Type of organization:Individual/sole proprietor or single-member LLC
C-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 Others =
Rental, Agent for Owner (M-1)County Employee
Rental of own property
Print name:
Signature required:Date:
Finance Dept. Use Only
Request for Information to Establish Vendor File
Thank you for your cooperation in completing this form and returning it to:
PAYMENT NAME and address:
DO NOT ALTER - DO NOT REMOVE OR ADD
101 Aupuni Street, Unit 230, Hilo, HI 96720
Nyssa Hatorii
808-961-8218 808-961-8684
Liquor Control
501c3 non profit organization/Grant