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Note: All fields with an asterisk(**) next to it must be completed
 
Company Info  
Company Name **    
Contact Person **    
Email address **  
Telephone ) - **(Please Insert as 123-123-1234 format)
Fax ) - ***(Please Insert as 123-123-1234 format)
 
Physical Address
Street **    
Street2 **    
City **    
State **    
Zip **    
 
Mailing Address
Street1 **    
Street2 **    
City **    
State **    
Zip **    
 
Financial Data
Reporting period **  
Sales (revenue) **  
 
Cost of sales (labor & material)
(Material Cost and Direct Labor do not include Selling, General & Administrative expenses)
Material cost: **  
Direct labor: **  
 
Cost of sales
   
Operating expenses **  
Other income **  
Other expenses **  
 
Cost of labor (dl / sales)
Gross profit (sales - cos)
Operating Income(gp - op exp)
Gross Profit Margin (gp / sales)
   
Add Backs
Amortization **  
Depreciation **  
Interest **  
Taxes (excluding payroll taxes) **  
Bank charges & penalties **  
Donations **  
Owners' excess salary **  
Bonus (profit sharing) to owner **  
Payroll tax on owners' excess salary & bonus **  
Owners' auto & auto insurance **  
Owners' meals & entertainment (not required for business purposes) **  
Owners' travel & lodging (not required for business) **  
Excess rent on owners' leased premises to company **  
Miscellaneous expense **  
Non-recurring expenses **  
Total Add Backs $    
Total Add Backs + Income from Operations $ = Adjusted EBITDA
   
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