Form 1099-K Merchant Card for Third Party Payments

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website, is
not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order
Information Returns and Employer Returns Online, and we’ll mail you the scannable
forms and other products.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

1010

VOID

CORRECTED

FILER’S name, street address, city, state, ZIP code, and telephone no.

FILER’S federal identification no. OMB No. 1545-2205

2012

PAYEE’S taxpayer identification no.

Form
1 Gross amount of payment card/
third party network transactions

Payment settlement entity (PSE)

Check to indicate transactions
reported are:
Payment card

Electronic Payment Facilitator
(EPF)/Other third party

Third party network

Check to indicate if FILER is a (an):

PAYEE’S name

Street address (including apt. no.)

City, state, and ZIP code
PSE'S name and telephone number

Account number (see instructions)

Form 1099-K

Cat. No. 54118B

Do Not Cut or Separate Forms on This Page

1099-K

Payment Card
and Third Party
Network
Transactions

2 Merchant category code

Copy A
For
Internal Revenue
Service Center

$
3 Number of purchase
transactions (optional)

4

5a January

5b February

$

$

5c March

5d April

File with Form 1096.

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

6

7

—

IRS.gov/form1099k

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2012 General
Instructions for
Certain Information
Returns.

8

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.

FILER’S federal identification no. OMB No. 1545-2205

2012

PAYEE’S taxpayer identification no.

Form
1 Gross amount of payment card/
third party network transactions

Payment settlement entity (PSE)

Check to indicate transactions
reported are:
Payment card

Electronic Payment Facilitator
(EPF)/Other third party

Third party network

Check to indicate if FILER is a (an):

PAYEE’S name

Street address (including apt. no.)

City, state, and ZIP code
PSE'S name and telephone number

Account number (see instructions)

Form 1099-K

(keep for your records)

1099-K

Payment Card
and Third Party
Network
Transactions

2 Merchant category code

Copy B
For Payee

$
3 Number of purchase
transactions (optional)

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

$

$

6

7

IRS.gov/form1099k

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.

8

Department of the Treasury - Internal Revenue Service

Instructions for Payee
You have received this form because you have either:
(a) accepted payment cards for payments, or (b)
received payments through a third party network that
exceeded $20,000 in gross total reportable transactions
and the aggregate number of those transactions
exceeded 200 for the calendar year. Merchant acquirers
and third party settlement organizations, 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 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 using the information reported on this form.
Payee's taxpayer identification number. For your
protection, this form may show only the last four digits
of your social security number (SSN), individual
taxpayer identification number (ITIN), or adoption

taxpayer identification number (ATIN). However, the
issuer has reported your complete identification number
to the IRS, and, where applicable, to state and/or local
governments. Note. If your EIN is reported in this box,
you should see the complete number in this format
(XX-XXXXXXX).
Account number. May show an account or other
unique number the PSE assigned to distinguish your
account.
Box 1. Shows the aggregate gross amount of payment
card/third party network transactions made to you
through the PSE during the calendar year.
Box 2. Shows the merchant category code used for
payment card/third party network transactions (if
available) reported on this form.
Box 3. May show the number of purchase transactions
(not including refund transactions) processed through
the payment card/third party network. (Optional—The
PSE is not required to complete this box for 2012.)
Boxes 5a–5l. Shows the gross amount of payment
card/third party network transactions made to you for
each month of the calendar year.
For the latest developments regarding Form 1099-K
that may occur after this form is printed, visit
www.irs.gov/form1099k.

VOID

CORRECTED

FILER’S name, street address, city, state, ZIP code, and telephone no.

FILER’S federal identification no. OMB No. 1545-2205

2012

PAYEE’S taxpayer identification no.

Form
1 Gross amount of payment card/
third party network transactions

Payment settlement entity (PSE)

Check to indicate transactions
reported are:
Payment card

Electronic Payment Facilitator
(EPF)/Other third party

Third party network

Check to indicate if FILER is a (an):

PAYEE’S name

Street address (including apt. no.)

City, state, and ZIP code
PSE'S name and telephone number

Account number (see instructions)

Form 1099-K

1099-K

Payment Card
and Third Party
Network
Transactions

2 Merchant category code

Copy C
For Filer

$
3 Number of purchase
transactions (optional)

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

$

$

6

7

IRS.gov/form1099k

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2012 General
Instructions for
Certain Information
Returns.

8

Department of the Treasury - Internal Revenue Service

Instructions for Payment Settlement Entity/
Electronic Payment Facilitator/Other third
party
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-K are the 2012 General
Instructions for Certain Information Returns and the
2012 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, 2013.

File Copy A of this form with the IRS by February 28,
2013. If you file electronically, the due date is April 1,
2013. 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.