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PROFIT AND LOSS STATEMENT
Please complete a separate Profit and Loss Statement for each business owned by the borrower(s).
Name(s) of Borrower(s):
Company Name:
Type of Business:
For the Period: through
DD/MM/YYYY DD/MM/YYYY
Income: Gross Sales and Receipts............................................................................................
Other Income: Other Income (interest, fees earned, etc.)……………................................................
Total Income (Gross Sales plus Other Income)..........................................................
Business Only
Expenses:
Salaries Paid to Owners (other than me/us)………..................
Salaries Paid to Employees (other than me/us)…....................
Benefits to Owners/Employees (other than me/us)……..........
Payroll Taxes…………………..….……………..……..................
Business Utilities………………………………..………...............
Business Rent and/or Mortgage Payments…...…....................
Insurance……………….…………………..…....………..............
Advertising………………….………..…...…….…………............
Telephone……………………..…...……………….……..............
Office Expenses…………….…..………………………..............
Repairs and Maintenance……….….…..…….…….…..............
Business Travel, Meals, and Entertainment……………..........
Other Business Expenses……………….…...…………............
Total Business Expenses............................................
Net Income/Loss: (Total Income minus Total Expenses)..............................................................
Amount of Net Income That Borrower(s) Received.......................................................................
This form accurately states my/our business expenses and self-employed income for the stated period.
Borrower Signature Date
Co-Borrower Signature Date
C3_12873_640375
