Retirement Plan

Proposal Request

Exact legal company name/person:

*

Address 1:

*

Address 2:

City:

*

State:

*

Zip:

*

Contact person:

*

Title:

*

E-Mail:

*

Phone:

*

Fax:

Type of business:

LLC

Sole Proprietor

Partnership

Regular Corp.

S-Corp.

Prof. Corp.

Business Inception Date:

*

Fiscal Year End:

*

Do any family members work for this business?

Yes

No

First name: Last name: Relationship:

Does employer currently have any other qualified retirement plan(s)?

Yes

No

If yes, what type?

Is this is a take-over?

Yes

No

If so, please provide a copy of the current plan documents and answer the following:

Number of employees:

Number of participants:

Annual Flow:

Existing assets:

What are the main objectives in opening the plan?

How much is the employer anticipating contributing annually?

Submitted by:

Broker/Agent name:

*

Date needed:

*

Address 1:

*

Address 2:

*

City:

*

State:

*

Zip:

*

Phone:

*

E-mail address:

*

Wholesaler/Referral source:

All information contained herein is for the sole purpose of preparing a qualified plan proposal. No information will be shared and will remain strictly confidential between the parties named.