Self-Employed Questionnaire

Business information required to properly analyze bank statements

  • Business Type: (product or service or both) If Other, please describe here:

Provide details of how income is generated:

  • Where do you conduct business: Office, Plant, Residence?

More than one physical site? (Check One) YES NO If Yes, how many?

  • What percentage of your business do you own?
  • If less than 100%, who owns the remaining portion and what percentage?
  • How many people do you have employed
    • Full Time:
    • Part Time:
    • Contractors:
    • Full Time Payroll:
    • Part Time Payroll:
    • Contractor Payroll:
  • Total Monthly Payroll Expense:
  • Do you manufacture a product, such that you have a cost of goods sold for the product you ultimately sell? Yes No. If yes, please describe Estimate for monthly Cost of goods sold:
  • Do you buy and then resell a product? (Check One) YES NO If YES, describe in detail:
  • Please provide any additional business expenses not listed above: (Excluding Rent / Payroll / COG Sold)
  • How has Covid-19 affected your business?
  • Is there anything else you can tell us about your business that is important for us to know as we review your bank statements, including sources of deposits and withdrawals?