Profit & Loss Statement (Sample) Page 2

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Rent
$
Licenses
$
Do not include Real Estate taxes for the property. Only include the
Taxes
$
taxes that you have to pay for the business.
$
Telephone
$
Depriciation / Depletion
Travel / Transportation
$
Utilities
$
Total amount and explanation of any other expenses not already
Other
$
listed above.
1.)
Explain:
$
Explain:
$
2.)
3.)
Explain:
$
Total Expenses
$
NET INCOME
Definition
Expense
Income
Net Income Before Taxes
Gross Income less Total Expenses
$
Taxes
Taxes paid on Business Income
$
Total Net Income After Taxes
Net Income less Taxes
$
Questionnaire:
Does your company pay you a Salary? Yes or No (circle one)
Does your company allow you to take Draws? Yes or No (circle one) If so, complete below:
Year to date Draws: $________________ (amount)
By signing this document, I/we certify that all the information is truthful. I/we understand that knowingly
submitting false information may constitute fraud.
Borrower: ____________________________
Co-Borrower: ____________________________
Signature: ____________________________
Signature:
____________________________
Date:
____________________________
Date:
____________________________

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