Vendor Registration

Payee Identification Number
Please note that this is a HIPPA compliant and secure form.

According to United States Tax Law, Goshen HELP is required to issue a 1099 to anyone receiving rent in excess of $600.

Due to the volume of requests we receive we require your tax ID to be on file for everyone receiving payment.
Name

First NameLast Name
Business Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Please enter your Tax ID number
Please Sign

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Date*

MonthDayYear
Date
Should be Empty:

Payee Identification Number