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 
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instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 
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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  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no.
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN                  Form 1099-K
                                                                                                                                           Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)              Network 
                                                                                 card/third party network 
                                                                                 transactions             For calendar year            Transactions
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code           Copy A 
                                                                                 transactions 
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                                 For 
                                      reported are:                                                                                    Internal Revenue 
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax           Service Center 
Electronic Payment Facilitator                                                   transactions                 withheld
(EPF)/Other third party               Third party network                                                 $                                     
PAYEE’S name                                                                 5a January                   5b February                  File with Form 1096. 
                                                                             $                            $ 
                                                                             5c March                     5d April                         For Privacy Act 
                                                                                                                                           and Paperwork 
Street address (including apt. no.)                                          $                            $                                Reduction Act 
                                                                             5e May                       5f  June                         Notice, see the 
                                                                             $                            $                                current General 
                                                                             5g July                      5h August                        Instructions for 
                                                                                                                                       Certain Information 
City or town, state or province, country, and ZIP or foreign postal code     $                            $                                    Returns. 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                         2nd TIN not.       6   State                    7   State identification no. 8   State income tax withheld
                                                                                                                                       $
                                                                                                                                       $
Form 1099-K (Rev. 1-2022)             Cat. No. 54118B                        www.irs.gov/Form1099K        Department of the Treasury - Internal Revenue Service
Do  Not  Cut  or  Separate  Forms  on  This  Page    —    Do  Not  Cut  or  Separate  Forms  on  This  Page

                                          VOID            CORRECTED 
FILER’S name, street address, city or town, state or province, country, ZIP  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no. 
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN                  Form 1099-K
                                                                                                                                           Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)              Network 
                                                                                 card/third party network 
                                                                                 transactions             For calendar year            Transactions
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code       Copy 1 
                                                                                 transactions 
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                             For State Tax 
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax           Department 
Electronic Payment Facilitator                                                   transactions                 withheld
(EPF)/Other third party               Third party network                                                 $
PAYEE’S name                                                                 5a January                   5b February
                                                                             $                            $ 
                                                                             5c March                     5d April
Street address (including apt. no.)                                          $                            $ 
                                                                             5e May                       5f  June
                                                                             $                            $ 
                                                                             5g July                      5h August
City or town, state or province, country, and ZIP or foreign postal code     $                            $ 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                                            6   State                    7   State identification no. 8   State income tax withheld
                                                                                                                                       $
                                                                                                                                       $
Form 1099-K (Rev. 1-2022)                          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  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no.
                                                                                                                                Payment Card and 
                                                                             PAYEE’S TIN                  Form 1099-K
                                                                                                                                           Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)              Network 
                                                                                 card/third party network 
                                                                                 transactions             For calendar year            Transactions
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code       Copy B 
                                                                                 transactions
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                             For Payee 
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax 
Electronic Payment Facilitator                                                   transactions                 withheld                     This is important tax 
(EPF)/Other third party               Third party network                                                 $                                information and is 
                                                                                                                                           being furnished to 
PAYEE’S name                                                                 5a January                   5b February                      the IRS. If you are 
                                                                             $                            $                                required to file a 
                                                                                                                                           return, a negligence 
                                                                             5c March                     5d April                         penalty or other 
Street address (including apt. no.)                                          $                            $                                sanction may be 
                                                                                                                                           imposed on you if 
                                                                             5e May                       5f  June                         taxable income 
                                                                             $                            $                                results from this 
                                                                                                                                           transaction and the 
                                                                             5g July                      5h August                     IRS determines that it 
City or town, state or province, country, and ZIP or foreign postal code     $                            $                                has not been 
                                                                                                                                           reported. 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                                            6   State                    7   State identification no. 8   State income tax withheld
                                                                                                                                       $
                                                                                                                                       $
Form 1099-K (Rev. 1-2022)             (Keep for your records)                www.irs.gov/Form1099K        Department of the Treasury - Internal Revenue Service

Instructions for Payee                                                    Box 1a. Shows the aggregate gross amount of payment card/third 
                                                                          party network transactions made to you through the PSE during the 
You have received this form because you have either (a) accepted          calendar year. 
payment cards for payments, or (b) received payments through a third 
party network in the calendar year reported on this form. Merchant        Box 1b. Shows the aggregate gross amount of all reportable payment 
acquirers and third party settlement organizations, as payment            transactions made to you through the PSE during the calendar year 
settlement entities (PSEs), must report the proceeds of payment card      where the card was not present at the time of the transaction or the 
and third party network transactions made to you on Form 1099-K           card number was keyed into the terminal. Typically, this relates to 
under Internal Revenue Code section 6050W. The PSE may have               online sales, phone sales, or catalogue sales. If the box for third party 
contracted with an electronic payment facilitator (EPF) or other third    network is checked, or if these are third party network transactions, 
party payer to make payments to you.                                      Card Not Present transactions will not be reported. 
If you have questions about the amounts reported on this form,            Box 2. Shows the merchant category code used for payment card/
contact the FILER whose information is shown in the upper left corner     third party network transactions (if available) reported on this form. 
on the front of this form. If you do not recognize the FILER shown in     Box 3. Shows the number of payment transactions (not including 
the upper left corner of the form, contact the PSE whose name and         refund transactions) processed through the payment card/third party 
phone number are shown in the lower left corner of the form above         network. 
your account number.                                                      Box 4. Shows backup withholding. Generally, a payer must backup 
If the Form 1099-K is related to your business, see Pub. 334 for          withhold if you did not furnish your TIN or you did not furnish the 
more information. If the Form 1099-K is related to your work as part of   correct TIN to the payer. See Form W-9, Request for Taxpayer 
the gig economy, see www.irs.gov/GigEconomy.                              Identification Number and Certification, and Pub. 505. Include this 
See the separate instructions for your income tax return for using        amount on your income tax return as tax withheld.
the information reported on this form.                                    Boxes 5a–5l. Show the gross amount of payment card/third party 
Payee’s taxpayer identification number (TIN). For your protection,        network transactions made to you for each month of the calendar 
this form may show only the last four digits of your TIN (social security year. 
number (SSN), individual taxpayer identification number (ITIN),           Boxes 6–8. Show state and local income tax withheld from the 
adoption taxpayer identification number (ATIN), or employer               payments.
identification number (EIN)). However, the issuer has reported your       Future developments. For the latest information about developments 
complete TIN to the IRS.                                                  related to Form 1099-K and its instructions, such as legislation 
Account number. May show an account number or other unique                enacted after they were published, go to www.irs.gov/Form1099K. 
number the PSE assigned to distinguish your account.                      Free File Program. Go to www.irs.gov/FreeFile to see if you qualify 
                                                                          for no-cost online federal tax preparation, e-filing, and direct deposit 
                                                                          or payment options.

                                                          CORRECTED (if checked)
FILER’S name, street address, city or town, state or province, country, ZIP  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no. 
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN                  Form 1099-K
                                                                                                                                           Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)              Network 
                                                                                 card/third party network 
                                                                                 transactions             For calendar year            Transactions
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code       Copy 2 
                                                                                 transactions 
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                                          
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax 
Electronic Payment Facilitator                                                   transactions                 withheld
(EPF)/Other third party               Third party network                                                 $
PAYEE’S name                                                                 5a January                   5b February
                                                                             $                            $ 
                                                                             5c March                     5d April
Street address (including apt. no.)                                          $                            $                             To be filed with the 
                                                                                                                                           recipient’s state 
                                                                             5e May                       5f  June                         income tax return, 
                                                                             $                            $                                when required. 
                                                                             5g July                      5h August
City or town, state or province, country, and ZIP or foreign postal code     $                            $ 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                                            6   State                    7   State identification no. 8   State income tax withheld
                                                                                                                                       $
                                                                                                                                       $
Form 1099-K (Rev. 1-2022)                          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  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no. 
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN                  Form 1099-K
                                                                                                                                           Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)              Network 
                                                                                 card/third party network 
                                                                                 transactions             For calendar year            Transactions
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code       Copy C 
                                                                                 transactions 
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                             For FILER 
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax 
Electronic Payment Facilitator                                                   transactions                 withheld
(EPF)/Other third party               Third party network                                                 $
PAYEE’S name                                                                 5a January                   5b February
                                                                                                                                           For Privacy Act 
                                                                             $                            $                                and Paperwork 
                                                                             5c March                     5d April                         Reduction Act 
Street address (including apt. no.)                                          $                            $                                Notice, see the 
                                                                             5e May                       5f  June                         current General 
                                                                                                                                           Instructions for 
                                                                             $                            $                            Certain Information 
                                                                             5g July                      5h August                        Returns.
City or town, state or province, country, and ZIP or foreign postal code     $                            $ 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                         2nd TIN not.       6   State                    7   State identification no. 8   State income tax withheld
                                                                                                                                       $
                                                                                                                                       $
Form 1099-K (Rev. 1-2022)                          www.irs.gov/Form1099K                                   Department of the Treasury - Internal Revenue Service

Instructions for FILER Who Is a Payment               Filing and furnishing. For filing and furnishing 
Settlement Entity or Electronic Payment               instructions, including due dates, and to request filing or 
                                                      furnishing extensions, see the current General 
Facilitator/Other Third Party                         Instructions for Certain Information Returns. 
To complete Form 1099-K, use:                         Need help? If you have questions about reporting on 
• The current General Instructions for Certain        Form 1099-K, call the information reporting customer 
Information Returns, and                              service site toll free at 866-455-7438 or 304-263-8700 
• The current Instructions for Form 1099-K.           (not toll free). Persons with a hearing or speech 
                                                      disability with access to TTY/TDD equipment can call 
To get and to order these instructions, go to         304-579-4827 (not toll free). 
www.irs.gov/EmployerForms. 
Caution: Because paper forms are scanned during 
processing, you cannot file certain Forms 1096, 1097, 
1098, 1099, 3921, or 5498 that you print from the IRS 
website.