Fillable Prot and Loss Statement (Wells Fargo)

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Prot and Loss Statement (Wells Fargo)

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(MM/DD/YY – MM/DD/YY)
Prot and Loss Statement
All borrowers who are self-employed or independent contractors should complete
this form if they do not already have their own prot and loss statement.
Company Name:
Company Address:
Type of Business:
Borrower Name(s):
Loan Number:
Dates Reported on this Form. Please provide year-to-date information starting from the month you opened
the business or from January of this calendar year:
Please complete the information below that applies to your business
Gross Income
Gross Sales
(Total amount of income from sales or services before subtracting expenses)
$
Other Income
(Any additional funds earned through the company, such as payments received
for leasing space)
$
Total Gross Income Before Taxes
$
Expenses
Cost of Goods Sold
(Direct costs to produce or obtain goods sold by the company)
$
Accounting and Legal Fees
$
Advertising
$
Business Rent
$
Business Telephone
$
Business Travel/Transportation
$
Business Utilities
$
Depreciation/Depletion
$
Insurance
$
Maintenance and Repairs
$
Meals and Entertainment
$
Postage
$
Continued on next page
0
Expenses (continued)
Prot and Loss Statement (continued)
Salary/Wage Expenses
(for borrowers on the mortgage)
$
Salary/Wage Expenses
(for employees who are not borrowers on the mortgage)
$
Supplies
$
Taxes
(Do not include real estate taxes on the property or income taxes on the
business. Include the total of any other taxes that you have to pay for the
business.)
$
Other Expenses
Total and explanation of any other expenses not already listed)
$
$
$
$
$
Total Expenses
$
Total Net Income (Gross income – expenses)
$
Borrower signatures(s)
By signing this document, I/we understand that the information and documents submitted are subject
to examination and verication. I/we understand that knowingly submitting false information may be
considered misrepresentation and/or fraud and may be referred to the appropriate law enforcement
authority for investigation.
Borrower Name Borrower Name
Signature Signature
Date Date
CS4988
© 2018 Wells Fargo Bank, N.A. All rights reserved. NMLSR ID 399801.
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Prot and Loss Statement (Wells Fargo)

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Completed 22 June 2022

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