Independent Contractor Form

June 20, 2011

An independent contractor form is created to indicate an agreement between the contractor and the person or organization the contractor will be working for. The form is used to gather information about the income the contractor receives from a particular business. It also used by the tax department to record the independent contractor’s tax information. Shown below is a sample independent contractor form.
Sample Independent Contractor Form

Payer’s Name ________________________

Address _____________________________

City, State, zip code ___________________

Telephone number _____________________

Payer’s identification number ____________

Recipient’s name ______________________

Address ______________________________

City, State, Zip code ___________________

Telephone number _____________________

Recipient’s identification number _________

Account number _______________________

Rents ________________________________

Royalties _____________________________

Other income __________________________

Federal income tax withheld ______________

Medical and health care payments __________

Non employee compensation ______________

Substitute payments _____________________

Insurance proceeds ______________________

Excess payments ________________________

Deferrals ______________________________

State tax withheld _______________________

Payer’s state number _____________________

State income ____________________________

 

Download Independent Contractor Form in Word Format

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