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HTML Preview Self Employment Profit & Loss Form page number 1.
1
Self Employm
ent Profit & Loss Form
You are
required
to co
mplete this form for the most recent t
hree months.
Submit one summary for
m
for
each of the last three
m
onths.
MONTH(S) T
HIS FORM INCLUDES:
INCOME/GROSS S
ALES:
$
If you pay yourself a salar
y or take a dra
w
from your business,
please provide
copies
of your pa
y
stubs for th
e last three months and
state the gross amount:
$
EXPENSES
–
Enter all that apply:
Rent/Mortgage of busine
ss premises
$
Phone/Utilities
$
Gross Labor Wages (not
for sel
f)
$
Business Taxes (not per
sonal income tax payments)
$
Loan payments:
Principle: $_
____
__
__
Interest: $____
__
___
Balance:
$
Bank Charges
$
License Fees Paid
$
Legal Fees
$
Office Supplies
$
Tools/Equip
m
ent
$
Repairs/Upkeep
$
Merchandise/Purchases/
Cost of Goods
$
Fuel/Gas
$
Advertising
$
Commissions Paid
$
Shipping
$
Equipment Rental
$
Insurance
$
Type of Insu
rance:
Other Expenses (please li
st):
$
$
$
TOTAL EXPENSES:
$
NET INCOM
E
$
BUSINESS VEHICLE
in your name:
Year: _____
Make: __
_____
___
__
Model: _________
BANK ACCOUNT
S
–
Include dates:
Balance in business c
hecking account :
Date: ___
__
____
$
Balance in business savi
ngs account :
Date: ______
__
_
$
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