Self-Employment Form

Are you self-employed?*

YesNo
Taxpayer Name*

First NameLast Name
Email
example@example.com
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
EIN Number?
Products/Services Provided?*
How do you get new customers?*
What methods of payments do you receive?*
What supporting documents do you have for your business? (ex. financial ledger, quick books, receipts, etc.)
What supplies are needed for this business?
Do you travel for business?*

YesNo
Did you receive a 1099-MISC form for income received?*

YesNo
Business Vehicle Information

Only complete this section if you are claiming vehicle expenses due to using your vehicle for the business
What vehicle is being used? (Year/Make/Model)
When was this vehicle first ever used for service in this business? (start date)
Total miles for business?
Total miles for personal use?
Was this vehicle available during off-work hours?

YesNo
Do you (or your spouse) have another vehicle available for personal use?

YesNo
What records have you maintained for this vehicle? (Ex. Mileage ledger, tracking device, etc.):
What methods are you using this year? (Ex. Tracking, mile ledger, quick books, cellular phone, etc.)
For Actual Expenses Method

Complete if you possibly want to use actual expenses instead of mileage method
Gas
Repairs/Maintenance
Insurance/Registration Fees
Parking Fees/Tolls
Other Expenses
Standard Mileage

67 cents per mile=business travel 21 cents per mile=medical 14 cents per mile=charitable
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Income Information
What records have you kept to track income?
January
July
February
August
March
September
April
October
May
November
June
December
Total Income:*
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Cost of Goods Sold

This section does not apply if you do not have goods to sell
Inventory at the start of the year (# of items)
Inventory at the end of the year (# of items)
Purchases: (Cash Amount For Materials)
Purchases: (Cash Amount For Supplies)
Did you pay any subcontractors?*

YesNo
Expenses
Advertising Expenses
Supplies
Rent/Lease Equipment
Utilities
Interest on Business Loans
Office Expense
Taxes Paid
Licenses and Permits
Insurance
Legal and Professional Services
Cell Phone
Other Expenses
Amount Paid to Employees
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Taxpayer Signature*

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I have provided the above information to LYW Financial for the preparation of my tax return.
Date*

MonthDayYear
Should be Empty:

Business Vehicle Information

For Actual Expenses Method

Standard Mileage

Income Information

Cost of Goods Sold

Expenses