Business Expense Form

Applicant Information
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APPLICANT
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MONTHLY
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YEARLY
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OTHER INCOME:
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BUSINESS INCOME ASSESSMENT

Please fill in only those amounts that apply towards your business.

Purchase of products and supplies far resale:
Insurance:
Workers Compensation, Business Insurance (do not inc!ude car or health insurance)
Labor Costs:
Advertising / Promotions:
(Commercials, Business Cards, Flyers, etc.)
TRAVEL EXPENSES:
*Lodging:
*Meals & Tips:
Plane/Train Ticket(s):
*Car Rental, Taxi or Bus Cost(s):
*Tolls:
*Fuel/Gas:
*Total Miles Traveled To/From Work(.55c x Mi.):
RENT:
*Machinery and Equipment:
Other Business Property:
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MONTHLY:
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YEARLY:
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Repairs / Maintenance:
(Building, Machinery, Not Inc!uding Vehicles)
Permits / Licenses:
Telephone Service:
Work Clothes:
Tools:
Other Expenses:
(Please Include anything that hasn't been mentioned prior)
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Vehicle Information
YEAR & CAR MODEL
Vehicle 1
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Vehicle 2
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Date of Purchase (MM/DD/YYYY)
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Submit