Business Name:
*
Business Address:
*
Business Phone #
*
EIN #
*
BELOW, WRITE IN THE AMOUNT YOU MADE EACH MONTH
*
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
TOTAL:
*
BELOW, WRITE IN THE AMOUNT OF EXPENSES THIS YEAR
*
ADVERTISING
OFFICE EXPENSES
RENT
UTILITIES
SUPPLIES
TAXES/LICENSES
LABOR/WAGES
MISC./OTHER
TRAVEL
MEALS
TOTAL:
All information that I ______________ (Taxpayer) have provided on this client data form is true and accurate to the best of my knowledge.
Clear
Taxpayers Signature:
Clear
Date
Submit
