IRS 1099-K Payment Card and Third Party Network Transactions Form

In the case of wanting to provide information to the IRS regarding third party network transactions, the following for has to be completed and submitted.

Extracted Text for Proper Search

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. 
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Information Returns and Employer Returns Online , a
 nd we’ll mail you the scannable 
forms an	
d other products.  
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about 
printing these tax forms.

Form  	1099-K	
2012	
Cat. No. 54118B	
Payment Card 
and Third Party  Network 
Transactions	
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  2012 General 
Instructions for 
Certain Information  Returns. 	
1010	VOID 	CORRECTED 	
FILER’S name, street address, city, state, ZIP code, and telephone no\
. 
Check to indicate if FILER is a (an): 
Payment settlement entity (PSE)
Electronic Payment Facilitator 
 (EPF)/Other third party	
Check to indicate transactions 
reported are:
Payment card 
Third party network 	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 payment card/third party network transactions
$ 	
2  Merchant category code	
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	8	
Form 	1099-K 	IRS.gov/form1099k	
Do  N ot  C ut  o r  S epara te   F orm s  o n  T his   P ag e    —     D o  N ot  C ut  o r  S epara te   F orm s  o n  T his   P ag e

Form  	1099-K	
2012	
Payment Card 
and Third Party  Network 
Transactions	
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\
. 
Check to indicate if FILER is a (an): 
Payment settlement entity (PSE)
Electronic Payment Facilitator 
 (EPF)/Other third party	
Check to indicate transactions 
reported are:
Payment card 
Third party network 	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 payment card/third party network transactions
$ 	
2  Merchant category code	
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	8
Form 	
1099-K 	(keep for your records) IRS.gov/form1099k

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.

Form  	1099-K	
2012	
Payment Card 
and Third Party  Network 
Transactions	
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  2012 General 
Instructions for 
Certain Information  Returns.	
VOID	CORRECTED 	
FILER’S name, street address, city, state, ZIP code, and telephone no\
. 
Check to indicate if FILER is a (an): 
Payment settlement entity (PSE)
Electronic Payment Facilitator 
 (EPF)/Other third party	
Check to indicate transactions 
reported are:
Payment card 
Third party network 	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 payment card/third party network transactions
$ 	
2  Merchant category code	
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	8
Form 	
1099-K 	IRS.gov/form1099k

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.