Request for Information

Requestor information

Contact Name: *    
Company Name: *    
Phone: *        Ext.  
Street Address 1: *    
Street Address 2:
City: *    
State: *   
Zip Code + 4: *      
Date needed by:      
E-mail:    

Select the type(s) of plan you would like information about

401(k) Only Plan
401(k) with Profit Sharing Plan


Profit Sharing Only Plan



Money Purchase / Defined Benefit / Cash Balance


Please describe the plan you are considering

Do you already have a plan*

Size of Plan
Enter without commas, period or dollar sign
Total annual payroll *    
Amount of takeover assets *    
Total # of employees *    

For all plan types other than 401(k) only plans

Employer's Contribution*    $    or % 
Enter without commas, period or dollar sign
Statement frequency



Investment direction


General Information

Do you currently have a relationship with a Financial Professional?*

Please enter any special instructions here:
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