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401k Request Form
Contact Information
*First Name :  
*Last Name :  
Company Name :  
City :  
State Residence :  
Street Address :  
Zip Code :  
Date of Birth :  
(mm-dd-yyyy)
*E-mail Address :  
Day Time Telephone :  
Evening Telephone :  
Best time to contact you :  
  How many full-time, W2 employees do you currently have working at your company?
 
  (Give the answer in numeric only-- e.g., 10, not ten.)
  Of the W2 employees indicated above, approximately how many are likely to participate in a new   retirement plan?  
  0-25%
  26-50%
  51-75%
  76-100%
  Not sure
  Does your business currently offer a retirement plan? If so, what is the current value of the
  plan's assets?
 
  We do not currently offer a retirement plan
  $0-99,999 in current assets
  $100,000-499,999 in current assets
  $500,000-999,999 in current assets
  $1,000,000+ in current assets
  Not sure
  When do you plan on starting or rolling over your retirement plan?    
  ASAP
  In one month
  In one to two months
  In more than one month
  What type of investment options are you considering for your retirement plan?
  (Check all boxes that apply)
  Not sure, please help me determine
  Multiple mutual funds in one fund family
  Multiple mutual funds in multiple fund families
  Self-directed brokerage account
  Other (please specify):
  Please describe in detail any additional requirements you may have relating to your interest in   employee retirement plans.
    
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