Business Profit/Loss Disclosure Form-Schedule C
Note: Must be updated every year.
Taxpayer's Name
*
First Name
Last Name
Spouse's Name
First Name
Last Name
Business Name
Employer ID Number
Ex. format (xxx-xx-xxxx)
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Principal Business or Profession
*
Principal Product or Service
Date Business Started
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
1099-NEC Income
Business Sales/Income (not reported on a Form 1099)
Please enter your business income- Gross Receipts
Costs of Goods Sold (Product Inventory Business)
Accounting Method
Cash
Accrual
Other
General Administration and Operations Expenses:
Advertising Costs
Commissions & fees
Contract Labor
Business related Interest Paid
Legal and Professional Fees
Insurance (excluding Health)
Office Expenses
Supplies, Mail/Delivery fees, Dry Cleaning, Office cleaning fees, etc.
Employee Wages
Pension/Profit-Sharing Plans
Employee Benefits Paid
Rent or Lease of Equipment
Repairs and Maintenance
Supplies
Travel
Airfare, Car Rentals, Tolls, Train, Towing, Parking fees, lodging.
Total Meal Expenses
Utilities
Business Phone Service
Cellphone Service
Light/Water/Gas
Supplies
Internet
Home Office Expenses
Do you have a home office that business is conducted in?
Yes
No
What is the square footage of the home, if applicable?
Square ft.
What is the square footage of the room or space used, if applicable?
Square ft.
House Fire Insurance
House Repairs & Maintenance
House Mortgage/Rent Expenses
House Property Tax
House Utilities
Gas, Electric, Water, Security, Heater etc.
Other Expenses:
List all other expenses here with the exact dollar amount:
$xx.xx
Vehicle Expenses
Vehicle Information
Please enter - Year, Make and Model
Vehicle Mileage
Rows
Business
Daily Commute
Volunteer
Mileage Used
What is the purchase cost of the vehicle?
When is the approximate date the vehicle was placed into service for your business?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What is the FMV of the vehicle if sold today?
Parking and Toll Fees
Car Registration and Tag Fees
Maintenance of Vehicle
Rows
Gas
Car Insurance
Repairs/Oil Changes
Tires
Other
Total Cost
Please Upload Receipts/Summary of charges if any:
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of
Bank and Credit Card Statements for Business Only:
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of
Taxpayer(s) Certifications:
*
I (Taxpayer) certify that the Business expenses provided are true and correct to the best of my knowledge.
I (Taxpayer) have provided true and accurate records to my Tax Professional to prepare my taxes.
I (Taxpayer) understand that my tax return will be prepared using the Business expenses that I have provided.
I (Taxpayer) reserve the right to check my tax return to ensure, that the information and expenses reflects the information I have provided.
I (Taxpayer) understand that I am responsible for maintaining my tax records and receipts for any expenses included in my return for up to 7 years.
In the event of an IRS Audit or Review, assistance is available with providing responses to the IRS. However, it is my (Taxpayer) sole responsibility to maintain my tax records and respond timely to any request for information from the IRS.
Signature
*
TAXPAYER CERTIFICATIONS: I (TAXPAYER) CERTIFY I (TAXPAYER) WOULD LIKE MY TAXES PREPARED IN ACCORDANCE WITH THE INFORMATION PROVIDED. I (TAXPAYER) RESERVE THE RIGHT TO CHECK THE RETURN TO MAKE SURE THAT THE INFORMATION ON IT REFLECTS INFORMATION ORIGINALLY GIVEN AND ON THIS QUESTIONAIRE
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Signature
*
Any services provided under this agreement must be paid “as Services Rendered”, even if you are under financial obligation to the IRS and/or the state in which you file. Therefore, the amount charged to complete your taxes must be paid, in full, at the time of service.
Submit
Submit
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