Shane Financial

Report Independent to EDD Form/Issue 1099s

Business Information:
Date: Tax ID:
EDD#: SSN: - -
Business Name: Contact Name:
Address: City: State: Zip Code:
Telephone: Cell: Fax:
Independent Contractor Information:
First Name: Middle Name: Last Name:
SSN: - - Address:
City: State: Zip Code:
Start Date of Contract: Amount of Contract:
Contract Expiration Date: Is the contract ongoing? Yes No
Would you like to issue the above independent a 1099s: Yes No if yes, what is the period: through in the year Amount
Independent Contractor Information:
First Name: Middle Name: Last Name:
SSN: - - Address:
City: State: Zip Code:
Start Date of Contract: Amount of Contract:
Contract Expiration Date: Is the contract ongoing? Yes No
Would you like to issue the above independent a 1099s: Yes No if yes, what is the period: through in the year Amount