Anderson Tax Experts Self-Employed affidavit
Client Information
Client Full Name:
Business Name:
Business Structure:
Sole Proprietor
LLC
S-Corp
Partnership
Other
EIN/SSN:
Business Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Preferred Contact:
Call
Text
Email
Business Overview
Type of Business/Services:
Years in Business:
Employees/Contractors:
Yes
No
| How Many?
Issue 1099s/W-2s:
Yes
No
Home Office Use:
Yes
No
Monthly Rent/Mortgage: $
Utilities: $
Income Details
Income Received Through:
Cash
Zelle
PayPal
Cash App
Square
Stripe
Bank Deposits
Sales Tracking Software:
Income Records:
Receipts
Sales Reports
Bank Statements
1099s
Total Reported Income: $
Expense Categories
Rows
Expense Category
Description
Amount
Notes
1
2
3
4
5
6
7
8
Other
*
$
*
Banking & Financial Records
Business Bank Statements Provided
*
Business Bank Statements Provided
Personal Account Used
*
Personal Account Used
Credit Card Statements
*
Credit Card Statements
Cash Receipts
*
Cash Receipts
Mileage Log
*
Mileage Log
Profit & Loss Statements
*
Profit & Loss Statements
Total Receipts:
*
Total Statements:
*
Tax-Related Questions
Quarterly Payments Made:
*
Yes
No
Received 1099s:
*
Yes
No
Have Prior Returns:
*
Yes
No
Owe Back Taxes:
*
Yes
No
Major Purchases (Vehicle/Equipment):
*
Yes
No
Notes / Preparer Observations
File Upload Section
Please attach scanned receipts, invoices, or statements here (digital upload if electronic form).
Upload all files here
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of
Signatures
Client Signature:
*
Date:
*
-
Month
-
Day
Year
Date Picker Icon
Preparer Name:
*
Date Received:
*
-
Month
-
Day
Year
Date Picker Icon
Signature
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