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<br />Form #: V-8 Vendor Number Assigned____________________ <br /> 04/16 Date/Initials ___________________ <br />Vendor Code ___________________ <br />Finance Dept. Use Only <br />Request for Information to Establish Vendor File <br />To establish a vendor file with the County of Hawaii, certain information is required. This information is necessary so <br />that we can report payments to the Internal Revenue Service on Form 1099 if they fall under the IRS information <br />reporting requirements. If you do not provide us with the information requested below, we may have to impose backup <br />withholding of 28% on any payments we make to you. Additional penalties are: <br />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 <br /> <br />such failure unless your failure is due to reasonable cause and not to willful neglect. <br />Civil Penalty for False Information With Respect to Withholding: If you make a false statement with no reasonable <br />basis that results in no backup withholding, you are subject to a $500 penalty. <br />ŷğƓƉ Ǥƚǒ ŅƚƩ ǤƚǒƩ ĭƚƚƦĻƩğƷźƚƓ źƓ ĭƚƒƦƌĻƷźƓŭ Ʒŷźƭ ŅƚƩƒ ğƓķ ƩĻƷǒƩƓźƓŭ źƷ Ʒƚʹ <br />DEPT.Office of Housing & Community Development <br />ADDRESS 50 Wailuku Drive Hilo, HI 96720 <br />REQUESTOR NAME:EHD Contact: Tricia Julian <br />Ph:(808) 959-4642Fax:(808) 959-9308 <br />COMPANY NAME: <br />INDIVIDUAL NAME <br />(If not corporation) <br />Correspondence/Order Address:PAYMENT NAME and address: <br />Name: <br />Address: <br />City/State/Zip: <br />Telephone:Fax:Email: <br />DO NOT ALTER - DO NOT REMOVE OR ADD <br />Individual/sole proprietor or single-member LLC <br />Type of organization: <br />C-CorporationPartnership <br />S-CorporationTrust/estate <br />Limited Liability Company <br />C = Corporation <br />S = Corporation <br />P = Partnership <br /> <br />Federal ID Number (SSN or FEIN): <br />State of Hawaii ID Number (GET): <br />Will be providing:ServicesBoth goods and services <br />Tangible goodsRefunds (Type O) <br />Rental, Licensed Agent for ownerOthers = <br />Rental, Agent for Owner (M-1)County Employee <br />Rental of own property <br />Form completed by:Date: <br /> 4664sdgc <br />