Iberville Parish Council
PO Box 389
Plaquemine, LA 70765-0389
Phone No. (225) 687-5190 or Fax No. (225) 687-5250
Iberville Parish Vendor Setup Form
Vendor Name:
Requested By

Dear Sir or Madam:

In order to comply with the Internal Revenue Service (IRS) From 1099 reporting rules, we are required to request the following information. To avoid unneccessary receipt of form 1099-Misc, please complete the form with the information listed below so we can record it to our computer database.

If you fail to provide your taxpayer identification number, the Parish of Iberville is required by law to withhold 20% (twenty percent) of your payment as backup withholding payable tot he IRS.
Individual's
Social Security Number
Business/Firm's
Federal Employer ID Number
Are you incorporated?
Are you federally tax exempt?
Please check the box below that best describes the type of transaction for which we make payments to you.
Describe Other Transaction Type
First Name
Last Name
Address
City
State
Zip Code
Phone
Fax
E-mail