"Self Employment Profit and Loss Form"

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Self Employment Profit & Loss Form
You are required to complete this form for the most recent three months. Submit one summary form for
each of the last three months.
MONTH(S) THIS FORM INCLUDES:
INCOME/GROSS SALES:
$
If you pay yourself a salary or take a draw from your business, please provide
$
copies of your paystubs for the last three months and state the gross amount:
EXPENSES – Enter all that apply:
$
Rent/Mortgage of business premises
$
Phone/Utilities
$
Gross Labor Wages (not for self)
$
Business Taxes (not personal income tax payments)
Loan payments:
Principle: $_________
Interest: $_________
Balance:
$
$
Bank Charges
$
License Fees Paid
$
Legal Fees
$
Office Supplies
$
Tools/Equipment
$
Repairs/Upkeep
$
Merchandise/Purchases/Cost of Goods
$
Fuel/Gas
$
Advertising
$
Commissions Paid
$
Shipping
$
Equipment Rental
$
Insurance
Type of Insurance:
$
Other Expenses (please list):
$
$
TOTAL EXPENSES:
$
NET INCOME
$
BUSINESS VEHICLE in your name:
Year: _____
Make: ____________
Model: _________
BANK ACCOUNTS – Include dates:
Balance in business checking account :
Date: _________
$
Balance in business savings account :
Date: _________
$
Self Employment Profit & Loss Form
You are required to complete this form for the most recent three months. Submit one summary form for
each of the last three months.
MONTH(S) THIS FORM INCLUDES:
INCOME/GROSS SALES:
$
If you pay yourself a salary or take a draw from your business, please provide
$
copies of your paystubs for the last three months and state the gross amount:
EXPENSES – Enter all that apply:
$
Rent/Mortgage of business premises
$
Phone/Utilities
$
Gross Labor Wages (not for self)
$
Business Taxes (not personal income tax payments)
Loan payments:
Principle: $_________
Interest: $_________
Balance:
$
$
Bank Charges
$
License Fees Paid
$
Legal Fees
$
Office Supplies
$
Tools/Equipment
$
Repairs/Upkeep
$
Merchandise/Purchases/Cost of Goods
$
Fuel/Gas
$
Advertising
$
Commissions Paid
$
Shipping
$
Equipment Rental
$
Insurance
Type of Insurance:
$
Other Expenses (please list):
$
$
TOTAL EXPENSES:
$
NET INCOME
$
BUSINESS VEHICLE in your name:
Year: _____
Make: ____________
Model: _________
BANK ACCOUNTS – Include dates:
Balance in business checking account :
Date: _________
$
Balance in business savings account :
Date: _________
$