BUSINESS INTAKE FORM

Self Employed Definition: An Individual who operates a business or profession as a soleproprietor, partner in a business relationship, independent contractor, or consultant. He/she must report self-employment income on Schedule C or Form 1040.

Self-Employed Name: *

Self-Employed Spouse Name

Employer Identification Number (if applicable) or SSN: *

Business Legal Name *

Business Physical Address *

Business City *

Business State *

Business Zip Code *

How many employees? (If Applicable)

How long have you owned your business? *

Do you have any documents to substantiate your business (formation documents, bills with compony name, etc.)? *

Is your business registered with the Secretary of State? *

Profit and Loss Statement(s)

If you cannot provide a profit and loss statement as proof of income and expenses your business, please complete the information below.

Income Made Each Month

January
February
March
April
May
June
July
August
September
October
November
December

If you cannot provide receipts as proof of your expenses for your business, please complete the information below.

EXPENSES

Advertising
Office Expenses
Rent/Lease
Utilities
Supplies
Taxes/Licenses
Repair and Maintenance
Travel
Meals (50%) Enter 100% of the expenses
Meals (30%) Enter 100% of the expenses
Wages (less employment credits)

Additional Information

The IRS may ask you to provide receipts so please keep your receipts on file for at least 5 YEARS. I certify that all statements are true to the best of my knowledge. I certify that I am not being forced or coerced in any way or form to report income falsely.

Taxpayer Signature *

Clear

Date-Taxpayer-Signed *

Spouse Signature

Clear

Date-Spouse-Signed

Choose Your Tax Professional *