Mack, Mack & Waltz Group

Dedicated to Your Insurance and Financial Needs

Worksheet for Business Income and Extra Expense Coverage

This worksheet simplifies the method for determining the total income and expense exposure for your business. If your business has multiple locations, please complete one worksheet for each location.

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Name
Estimated for 12 Month Period Beginning
Total Income & Expenses
Location 1
NET ANNUAL SALES - gross sales less discounts, returns, allowances, bad debt, colection expenses and prepaid outgoing freight, plus other earnings from your business such as cash discounts received, commisions, rents, interest, or service fees. If you are a manufacturer, you must also add or subtract the amount of the decrease.
COST OF GOODS SOLD
ORDINARY PAYROLL
NET INCOME & EXPENSES
REPAIR/REPLACE FACTOR
INCOME EXPOSURE
EXTRA EXPENSE EXPOSURE
EXTENDED INCOME EXPOSURE
LOCATION EXPOSURE
SQUARE FEET
Location 2
NET ANNUAL SALES - gross sales less discounts, returns, allowances, bad debt, colection expenses and prepaid outgoing freight, plus other earnings from your business such as cash discounts received, commisions, rents, interest, or service fees. If you are a manufacturer, you must also add or subtract the amount of the decrease.
COST OF GOODS SOLD
ORDINARY PAYROLL
NET INCOME & EXPENSES
REPAIR/REPLACE FACTOR
INCOME EXPOSURE
EXTRA EXPENSE EXPOSURE
EXTENDED INCOME EXPOSURE
LOCATION EXPOSURE
SQUARE FEET
TOTAL INCOME & EXPENSES (ALL LOCATIONS)
POLICY LIMIT
Additional Comments
Please give any additional comments about the coverage you desire:

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