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<br />Form #: V-8 Vendor Number Assigned <br /> <br />Date/Initials <br />w11/17 <br />Vendor Code <br /> <br /> <br /> <br />Finance Dept. Use Only <br /> <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 that we <br />can report payments to the Internal Revenue Service on Form 1099 if they fall under the IRS information reporting <br />requirements. If you do not provide us with the information requested below, we may have to impose backup withholding of <br />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 such failure unless <br />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 basis that results in no <br />backup withholding, you are subject to a $500 penalty. <br />DEPT. <br />Office of Housing & Community Development <br />ADDRESS <br />1990 Kinoole Street, Suite 105 Hilo, HI 96720 <br />REQUESTOR NAME: EHD Contact: Megan DeCoito <br />Ph: 808-959-4642 Fax: 808-959-9308 <br /> <br /> <br /> <br />COMPANY NAME: <br /> <br /> <br />INDIVIDUAL NAME <br />(If not corporation) <br /> <br />Correspondence/Order Address: PAYMENT NAME and address: <br />Name: Not Applicable <br />Not Applicable <br />Address: <br />Not Applicable <br />City/State/Zip: <br /> Fax: <br />Telephone: Email: <br /> <br />DO NOT ALTER DO NOT REMOVE OR ADD <br /> <br />Type of organization: Individual/sole proprietor or single-member LLC <br /> C-Corporation Partnership <br /> S-Corporation Trust/estate <br /> <br /> Limited Liability Company <br /> C = Corporation <br /> S = Corporation <br /> P = Partnership <br /> <br /> <br />Federal ID Number (SSN or FEIN): <br /> <br />State of Hawaii ID Number (GET): <br /> <br />Will be providing: Services Both goods and services <br /> Tangible Goods Refunds (Type O) <br /> Rental, Licensed Agent for owner Others = <br /> Rental, Agent for Owner (M-1) County Employee <br /> Rental of own property <br /> <br />Print name: <br /> <br />Signature Required: <br />Date: <br /> <br /> <br />