Fillable Printable Form 1099K
Fillable Printable Form 1099K
Form 1099K
Form 1099-K
2011
Cat. No. 54118B
Merchant Card
and Third Party
Network Payments
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.
1010
VOID CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.
Check box if FILER is Payment Settlement Entity (PSE)
OR
Check box if FILER is Electronic Payment Facilitator (EPF)/
Third Party Payer (TPP)
PAYEE’S name
Street address (including apt. no.)
City, state, and ZIP code
PSE'S name and telephone number
Account number (see instructions)
FILER’S federal identification no.
PAYEE’S taxpayer identification no.
1 Gross amount of merchant
card/third party network
payments
$
2 Merchant category code
3 4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
Form 1099-K
IRS.gov/form1099k
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-K
2011
Merchant Card
and Third Party
Network Payments
Copy B
For Payee
Department of the Treasury - Internal Revenue Service
This is important tax
information and is
being furnished to
the Internal Revenue
Service. If you are
required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
taxable income
results from this
transaction and the
IRS determines that it
has not been
reported.
OMB No. 1545-2205
CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.
If checked, FILER is Payment Settlement Entity (PSE)
OR
If checked, FILER is Electronic Payment Facilitator (EPF)/
Third Party Payer (TPP)
PAYEE’S name
Street address (including apt. no.)
City, state, and ZIP code
PSE'S name and telephone number
Account number (see instructions)
FILER’S federal identification no.
PAYEE’S taxpayer identification no.
1 Gross amount of merchant
card/third party network
payments
$
2 Merchant category code
3 4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
Form 1099-K
(Keep for your records) IRS.gov/form1099k
Instructions for Payee
You have received this form because you have
accepted merchant cards for payments, or because you
received payments through a third party network that (1)
exceeded $20,000 in gross total reportable payment
transactions and (2) the total number of those
transactions exceeded 200 for the calendar year.
Merchant card and third party network payers, as
payment settlement entities (PSE), must report the
proceeds of payment card and third party network
transactions made to you on Form 1099-K under
Internal Revenue Code section 6050W. The PSE may
have contracted with an electronic payment facilitator
(EPF) or other third party payer (TPP) to make payments
to you.
If you have questions about the amounts reported on
this form, contact the FILER whose information is
shown in the upper left corner on the front of this form.
If you do not recognize the FILER shown in the upper
left corner of the form, contact the PSE whose name
and phone number are shown in the lower left corner of
the form above your account number.
See the separate instructions for your income tax
return for how to use the information reported on this
form.
Account number. May show an account number or
other unique number the PSE assigned to distinguish
your account.
Box 1. Shows the aggregate gross amount of merchant
card/third party network payments made to you through
the PSE during the tax year.
Box 2. Shows the merchant category code used for
merchant card/third party network payments (if
available) reported on this form.
Boxes 5a-5l. Shows the gross amount of merchant
card/third party network payments received by you for
each month of the calendar year.
For the latest developments regarding Form 1099-K
that may occur after these instructions are printed, visit
www.irs.gov/form1099k.
Form 1099-K
2011
Merchant Card
and Third Party
Network Payments
Copy C
For Filer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.
VOID CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.
Check box if FILER is Payment Settlement Entity (PSE)
OR
Check box if FILER is Electronic Payment Facilitator (EPF)/
Third Party Payer (TPP)
PAYEE’S name
Street address (including apt. no.)
City, state, and ZIP code
PSE'S name and telephone number
Account number (see instructions)
FILER’S federal identification no.
PAYEE’S taxpayer identification no.
1 Gross amount of merchant
card/third party network
payments
$
2 Merchant category code
3 4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
Form 1099-K
IRS.gov/form1099k
Instructions for Payment Settlement Entity/
Third Party Payer
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-K are the 2011 General
Instructions for Certain Information Returns and the
2011 Instructions for Form 1099-K. A chart in the
general instructions gives a quick guide to which form
must be filed to report a particular payment. To order
these instructions and additional forms, visit IRS.gov or
call 1-800-TAX-FORM (1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, 3922, or 5498 that you print from the IRS
website.
Due dates. Furnish Copy B of this form to the recipient
by January 31, 2012.
File Copy A of this form with the IRS by February 28,
2012. If you file electronically, the due date is April 2,
2012. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220, Specifications for Filing Forms 1097, 1098, 1099,
3921, 3922, 5498, 8935, and W-2G Electronically. The
IRS does not provide a fill-in form option.
Need help? If you have questions about reporting on
Form 1099-K, call the information reporting customer
service site toll free at 1-866-455-7438 or 304-263-8700
(not toll free). For TTY/TDD equipment, call
304-579-4827 (not toll free). The hours of operation are
Monday through Friday from 8:30 a.m. to 4:30 p.m.,
Eastern time.
For the latest developments regarding Form 1099-K
that may occur after these instructions are printed, visit
www.irs.gov/form1099k.
