Self Employed/Business Form
Please enter total dollar amount spent on each expense category during 2023. Ensure that your financial records support the information entered below.
Business Information
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Name of Business leave blank if your name)
EIN (leave blank if your social security number)
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a home office?
Please Select
Yes
No
I use both a commercial space and a home office for my business
Income (Gross Receipts or Sales)
Total income from work or sales
*
Expenses
1. Advertising
*
2. Car/Truck Expenses
*
3. Commissions and Fees
*
4. Contract Labor
*
5. Depletion
*
6. Depreciation
*
7. Employee Benefit Programs (other than pension and profit-sharing plans)
*
8. Insurance (other than health)
*
9. Interest
*
9a. Mortgage
*
9b. Other
10. Legal and Professional Services
*
11. Office Expense
*
12. Pension and Profit-Sharing
*
13. Rent or Lease
*
13a. Vehicles, machinery, equipment
*
13b. Other business property
*
14. Repairs and Maintenance
*
15. Supplies
*
16.Taxes and Licenses
*
17. Travel and Meals
*
17a. Travel
*
17b. Deductible Meals
*
18. Utilities
*
19. Wages (less employement credits)
*
20. Other Expenses
*
Please add all expesenses and enter the total number in the box below:
Total 2023 Expenses
*
By signing below, you attest that all information entered above is accurate.
*
Submit
Should be Empty: