OMB No. 1545–1059

7018-A Employer’s Order Blank for 2004 Forms Form

(Rev. November 2003)

Department of the Treasury

Internal Revenue Service

Attention:

Postal Mailing Address:

City:

Print

or

Type

Only

Company Name:

Instructions. Enter the quantity next to the form you are ordering. Please order the number of forms needed, not the number of sheets. Note: None

of the items on the order blank are available from the IRS in a continuous-feed version. All forms on this order blank that require multiple copies are

carbonized so that you will not have to insert carbons. You will automatically receive one instruction with any form on this order blank. Type or print your

name and complete mail delivery address in the space provided below. An accurate mail delivery address is necessary to ensure delivery of your order.

Visit the IRS website at www.irs.gov.

Foreign Country:

Daytime Telephone Number:

International Postal Code:

State: Zip Code:

Cat. No. 43709Q

Send your order to the Internal Revenue Service address for the Area

Distribution Center closest to your state.

Where To Send Your Order

Central Area Distribution Center

P.O. Box 8908

Bloomington, IL 61702-8908

Eastern Area Distribution Center

P.O. Box 85075

Richmond, VA 23261-5075

Western Area Distribution Center

Rancho Cordova, CA 95743-0001

Paperwork Reduction Act Notice. We ask for the information on this form to

carry out the Internal Revenue laws of the United States. Your response is

voluntary.

The time needed to complete this form will vary depending on the individual

circumstances. The estimated average time is 3 minutes. If you have

comments concerning the accuracy of this time estimate or suggestions for

making this form simpler, we would be happy to hear from you. You can write

to the Tax Products Coordinating Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001.

Do not send your order Form 7018-A to the Tax Products Coordinating

Committee. Instead, send your forms order to the IRS Area Distribution Center

closest to your state.

You are not required to provide the information requested on a form that is

subject to the Paperwork Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration

of any Internal Revenue law. Generally, tax returns and return information are

confidential, as required by Code section 6103.

Item

W-4 S

W-2 C

W-3

W-3 C

W-4

W-4 P

1099 B

1096

1099 A

1099 S

1099 DIV

1099 INT

1099 MISC

1099 LTC

1099 PATR

1099 R

5498

Pub 1494

Quantity

1099 C

W-2 Wage and Tax Statement

Corrected Wage and Tax Statement

Transmittal of Wage and Tax

Statements

Transmittal of Corrected Wage and Tax

Statements

Employee’s Withholding Allowance

Certificate

Withholding Certificate for Pension or

Annuity Payments

Request for Federal Income Tax

Withholding From Sick Pay

Earned Income Credit Advance

Payment Certificate

Annual Summary and Transmittal of

U.S. Information Returns

Acquisition or Abandonment of

Secured Property

Proceeds From Broker and Barter

Exchange Transactions

Cancellation of Debt

Dividends and Distributions

Interest Income

W-5

Miscellaneous Income

1099 OID

5498 MSA

1099 MSA Distributions From an Archer MSA or

Medicare+Choice MSA

Long-Term Care and Accelerated

Death Benefits

Original Issue Discount

Taxable Distributions Received From

Cooperatives

Distributions From Pensions, Annuities,

Retirement or Profit-Sharing Plans,

IRAs, Insurance Contracts, etc.

Proceeds From Real Estate

Transactions

IRA Contribution Information

Archer MSA or Medicare+Choice MSA

Information

Table for Figuring Amount Exempt From

Levy On Wages, Salary, and Other Income

(Forms 668-W(c) and 668-W(c)(DO))

Quantity Item Title Title

1098 E Student Loan Interest Statement

USE THIS PORTION FOR 2004 FORMS ONLY

1098 T Tuition Statement

1098 Mortgage Interest Statement

1099 H Health Insurance Advance Payments

Pub 15 A Employer’s Supplemental Tax Guide

Pub 15 B Employer’s Tax Guide to Fringe

Benefits

Ste/Room

( )

1099 Q Payments From Qualified Education

Programs (Under Sections 529 and 530)

5498 ESA Coverdell ESA Contribution Information

1099 G Certain Government Payments
Internal Revenue Service

WADC–9999 Bulk Rate

Rancho Cordova, CA 95743-9999 Postage and Fees Paid

Internal Revenue Service Official Business

Penalty for Private Use $300 Permit No. G-48

Deliver to Payroll Department

Postmaster: Deliver Immediately