Form 1099-K Payment Card and Third Party Network Transactions

Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on
Employer and Information Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.

1010

VOID

CORRECTED

FILER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

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

2016

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

$

Form

1b Card Not Present
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):

1099-K

2 Merchant category code

$
3 Number of payment
transactions

4 Federal income tax
withheld

5a January

5b February

$

PAYEE’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2016 General
Instructions for
Certain Information
Returns.

$

2nd TIN not. 6 State

Account number (see instructions)

Payment Card and
Third Party
Network
Transactions

7 State identification no.

8 State income tax withheld

$
$
Form 1099-K

Cat. No. 54118B

Do Not Cut or Separate Forms on This Page

www.irs.gov/form1099k

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

FILER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

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

2016

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

$
1b Card Not Present
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 or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number

Account number (see instructions)

Form

Payment Card and
Third Party
Network
Transactions

1099-K

2 Merchant category code

Copy 1
For State Tax
Department

$
3 Number of payment
transactions

4 Federal income tax
withheld

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 State

7 State identification no.

8 State income tax withheld

$
$
Form 1099-K

www.irs.gov/form1099k

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
FILER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

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

2016

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

$

Form

1b Card Not Present
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):

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number

Account number (see instructions)

1099-K

2 Merchant category code

Copy B
For Payee

$
3 Number of payment
transactions

4 Federal income tax
withheld

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.

$
5a January

PAYEE’S name

Payment Card and
Third Party
Network
Transactions

5b February

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$

$

6 State

7 State identification no.

8 State income tax withheld

$
$
Form 1099-K

(Keep for your records)

www.irs.gov/form1099k

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.

Box 1b. May show the aggregate gross amount of all reportable
payment transactions made to you through the PSE during the
calendar year where the card was not present at the time of the
transaction or the card number was keyed into the terminal. Typically,
this relates to online sales, phone sales, or catalogue sales. If the box
for third party network is checked, or if these are third party network
transactions, card not present transactions will not be reported.
Box 2. Shows the merchant category code used for payment card/
third party network transactions (if available) reported on this form.
Box 3. Shows the number of payment transactions (not including
refund transactions) processed through the payment card/third party
network.
Box 4. Shows backup withholding. Generally, a payer must backup
withhold if you did not furnish your taxpayer identification number
(TIN) or you did not furnish the correct TIN to the payer. See Form
W-9, Request for Taxpayer Identification Number and Certification,
and Publication 505, Tax Withholding and Estimated Tax, for
information on backup withholding. Include this amount on your
income tax return as tax withheld.

Payee's 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), adoption taxpayer
identification number (ATIN), or employer identification number (EIN).
However, the issuer has reported your complete identification number
to the IRS.

Boxes 5a-5l. Shows the gross amount of payment card/third party
network transactions made to you for each month of the calendar
year.

Account number. May show an account number or other unique
number the PSE assigned to distinguish your account.

Future developments. For the latest information about developments
related to Form 1099-K and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/form1099k.

Box 1a. Shows the aggregate gross amount of payment card/third
party network transactions made to you through the PSE during the
calendar year.

Boxes 6-8. Shows state and local income tax withheld from the
payments.

CORRECTED (if checked)
FILER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

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

2016

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

$
1b Card Not Present
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 or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number

Account number (see instructions)

Form

Payment Card and
Third Party
Network
Transactions

1099-K

2 Merchant category code

Copy 2

$
3 Number of payment
transactions

4 Federal income tax
withheld

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 State

7 State identification no.

To be filed with the
recipient's state
income tax return,
when required.

8 State income tax withheld

$
$
Form 1099-K

www.irs.gov/form1099k

Department of the Treasury - Internal Revenue Service

VOID

CORRECTED

FILER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

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

2016

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

$
1b Card Not Present
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):

1099-K

2 Merchant category code

Copy C
For FILER

$
3 Number of payment
transactions

4 Federal income tax
withheld

5a January

5b February

$

PAYEE’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number

$

$

5c March

5d April

$

$

5e May

5f June

$

$

5g July

5h August

$

$

5i September

5j October

$

$

5k November

5l December

$
Account number (see instructions)

Form

Payment Card and
Third Party
Network
Transactions

2nd TIN not. 6 State

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2016 General
Instructions for
Certain Information
Returns.

$
7 State identification no.

8 State income tax withheld

$
$
Form 1099-K

www.irs.gov/form1099k

Department of the Treasury - Internal Revenue Service

Instructions for FILER Who is a Payment
Settlement Entity or Electronic Payment
Facilitator/Other Third Party
To complete Form 1099-K, use:
• the 2016 General Instructions for Certain Information
Returns, and
• the 2016 Instructions for Form 1099-K.
To order these instructions and additional forms, go
to www.irs.gov/form1099k.
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, 2017.
File Copy A of this form with the IRS by February 28,
2017. If you file electronically, the due date is March 31,
2017. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220, Specifications for Electronic Filing of Forms 1097,
1098, 1099, 3921, 3922, 5498, and W-2G. 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). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).