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Business Owner Name

Address

Street Address

City

State

Country

Postal code

Primary Telephone *

Secondary Telephone

Email *

Secondary Email

Business Name & EIN #

Business Start Date

DBA (Doing Business As)

Business Address 3

Business Address 2

Primary Business Activity/Type: (What does your business do?)

Date of Incorporation

Number of Employees

New Ownership Acquisition Date (If Applicable)

Partner 1

Partner Name

Percentage Of Ownership

Partner 2

Partner Name

Percentage Of Ownership

Partner 3

Partner Name

Percentage Of Ownership

Fiscal Year

Calendar Year

Fiscal Year

If Fiscal, what is year-end?

Tax ID

Gross Yearly Revenue: $

$

Advertising

CAR & TRUCK EXPENSES

Legal & Professional Services

Employee Salary and Other Compensation

Accounting

Office Expenses

RENT & LEASE PAYMENTS

UTILITIES/TELEPHONE

BUSINESS MILES

REPAIR MAINTENANCE

Supplies

Travel, Meals, and Entertainment

TAXES & LICENSES

Software

Educational Expenses (Must Be Business Related)

Interest on Business Purchases

Postage and Logistics

Charitable Contributions

Casualty and Theft Losses

Bad Debts (deductible if the business sells goods instead of providing services)

Other Expenses

Total Business Miles

Business Documents

Business Document 2

Business Document 3

Expense 1

Expense 2

Expense 3

Rent / Office

I certify that all the above information given to the tax preparer to prepare my income tax return is accurate and true to the best of my knowledge.

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