Self Employment/Contractor Form

Self-Employment / Independent Contractor Form

Per IRS due-diligence requirements, we must maintain detailed records to support all self-employment income and expenses reported on Schedule C.Completion of this form is required to ensure accuracy and compliance.
Business Expense Tracking

Use this section to report business expenses related to your self-employment or independent contractor work.Only enter expenses that are ordinary and necessary for your business.Do not include personal expenses.
Business Owner Name

First NameLast Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this your first year in business?
EIN Number (Federal ID)
Did you make payments requiring a Form 1099?
If ‘YES’ did you file required Form 1099?

Retail Businesses ONLY

Rows	Money Spent
Beginning Inventory
Merchandise Purchased for Resale
Cost Of Labor (Do not include $ paid to yourself)
Material & Supplies
Other Direct Sales Costs
Ending Inventory

ALL Business

Rows	Money Spent
Advertising
Commissions and Fees
Contract Labor (1099's Issued, if app)
Insurance (Other Than Health)
Health Insurance (For Yourself)
Health Insurance (For Your Employees)
Mortgate Interest (If Paid For Business)
Other Interest Paid
Professional Fees
Office Expenses
Rent on Business Property
Equipment Rentals
Telephone Used form Business
Repairs and Maintenance
Supplies
Real Estate Taxes (If paid for Business)
Other Taxes (Payroll)
Travel ( Do not Include Meals)
Meals & Entertainment
Utilities
Wages (W2's Issued)
Bank and CC Charges
Uniforms/Logo/Apparel
Tools
License/Dues
Business Internet
Other

Total Business Mileage for the Year
If yes, is the “evidence” written?
Evidence” includes mileage logs, appointment records, calendars, etc. plus IRS could ask for odometer readings from oil changes, repair invoices, purchase and sale documents.
Did you purchase any major pieces of equipment?
What kind of Equipment? blanks Date Amount:
Do you have an Office In your Home?

Home Office ONLY

I certify that I have listed all income, all expenses, and I have documentation to back up the figures entered on this worksheet. This is for Tax Year blanks*
Printed Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Should be Empty:

Self-Employment / Independent Contractor Form