Self-Employment Form

Self-Employment Form

Business owners or Contracted workers
Name

First NameLast Name
Address (List business address if different from home address.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Name
(List company if you have a 1099 form.)
Business EIN
Type Of Business
(Ex: Barber, Baby sitter, and etc.)
What year did you start your business?
Were you issued a 1099 for your business?

YesNo
Gross Receipts/Sales or Income Reported on 1099
(List the total amount of money you made for the year.)
Do you have a business bank account?

YesNo
If no, please list an explanation of how you seperate business and personal expenses.
Do you have employees or contractors?

YesNo
Did you pay quarterly taxes during the year?

YesNo
How do you keep your records? Please list a brief description explanation of income.
(Ex: Receipts, Spread Sheets, or other.)
Do you have a home office?

YesNo
If yes, what is the square foot of the home and square foot of the space that is used.
Do you have a vehicle?

YesNo
How is your vehicle operated?

Personal useBusiness useBoth
When was vehicle placed in business service?
(List the month and year you started to use your vehicle for the business.)
Mileage
Please list the evidence to support your mileage deduction.
- Do you have inventory?
  
  YesNo
- Inventory at beginning of year
- Inventory at the end of year
- Cost of goods sold
- Advertising
- Car and Truck Expenses
- Commissions & Fees
- Contract Labor
- Depletion
- Depreciation
- Employee Benefits
- Insurance
- Legal/Pro Services
- Office Expenses
- Pension Plans
- Rent or Lease
- Machinery or Equipment
- Other Property
- Repairs & Maintenance
- Supplies
- Taxes & Licenses
- Travel
- Meals
- Utilities
- Wages
- Other Expenses
- Other Expenses. List below business expenses not included from options above.
- If you do not choose to write off expenses, please explain why.
- I agree that everything on the sheet is true to my acknowledgement and is based on records kept during the current year and is related expense to my business profession.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: