MT CLEMENS

Self-Employment Questionnaire

Tax Preparer *

Full Name *

Business Name

Business Type

Years in business

Business Address

Gross Income *

Expenses *

Advertising
Car & Truck
Commissions & Fees
Contract Labor
Home Office Expenses
Depreciation
Insurance (Other than health)
Interest
Legal and Professional Services
Office Expenses
Rent or Lease of Equipment
Repair or Maintenance
Supplies
Taxes and Licenses
Travel
Meals
Utilities
Entertainment
Wages
Other Expenses
Business Miles (Will need log)

Did you receive a 1099-NEC or 1099-MISC for the tax year? *

Yes

I agree to terms & conditions provided by the company. I confirm everything stated in the form is the truth to the best of my knowledge.

Signature *