Request for Form W-9

February 4, 2013

If you make payment or payments to a vendor during the year that will require you to send an IRS Form 1099-MISC to that vendor, then you need to obtain an executed Form W-9 from the vendor before or soon after making payments.

To download this form, click here: Letter Requesting W-9.doc




To Whom It May Concern:


Our records indicate that we do not have a new or current W-9 Form on file certifying your Taxpayer Identification Number. Our medical practice is required to obtain this information. A new W-9 Form is also required to report any change including address changes.

For your convenience, the following is the link to the IRS website where you can download a Form W-9:

The business name, address and tax identification number must match your billing statements and should contain the business name as it appears on your income tax return. If the W-9 does not match the billing statement we may be unable to issue a payment. Additionally, if the W-9 is not received shortly, all future payments will be withheld.

Please submit the completed W-9 by faxing it to __________, attention ___________.  We would appreciate you also providing your current telephone number and fax number.

Thank you in advance for your attention to this matter. If you have any questions, I can be reached at ____________.






To download this form, click here: Letter Requesting W-9

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