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401K Employer Application
Please enter your information below and we'll get started setting everything up for you. This site is secured with industry-leading SSL encryption. Your information is safe, and you'll only enter information that is required to join. A pdf / paper version of this form is available upon request.
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Company Name:
Company Name
Required Field
Required Field
Company EIN (no dashes)
EIN
Required Field
Required Field
Entity Type
- select a option -
S-Corporation (or LLC taxed as S-corp)
LLC
LLP
C-Corporation
Sole Proprietor
- select a option -
Required Field
Required Field
Company Address:
Company Address
Required Field
Required Field
City:
City
Required Field
Required Field
State:
- select a state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
- select a state -
Required Field
Required Field
Zip Code
Zipcode
Required Field
Required Field
Company Phone Number:
Company Phone Number:
Required Field
Required Field
Fiscal Year End:
Required Field
Required Field
Entity Effective Date:
Required Field
Required Field
PLAN CONTACT INFO
For each Plan Contact listed below, please indicate the Role Type(s) that should be assigned. Payroll Processing – responsible for uploading payroll contribution files to The Social 401K upload website each payroll period. This Role Type will also receive notification emails of contribution totals that are submitted to (via ACH transaction) each payroll period. Distributions – responsible for the review and approval of participant distribution requests Loans – responsible for the review and approval of participant loan requests Compliance (Testing/5500) – responsible for the annual submission of employer information and participant census data for year-end compliance reporting. Note: Not necessary for Fellow Travelers payroll clients (included with payroll services). Each Role Type may be assigned to multiple Plan Contacts listed below.
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Primary Plan Contact
As Primary Plan Contact, this individual will be granted all Role Types (described above). If other employer representatives should be granted specific Role Types, please list the individual as an Additional Plan Contact below.
Primary Contact:
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Primary Contact First Name:
Primate Contact's First Name
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Primary Contact Last Name:
Primary Contact's Last Name
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Primary Contact Email Address:
Primary Contact Email Address:
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Primary Contact Phone Number
Primary Contact Phone Number
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Primary Contact Cell Phone Number:
Primary Contact Cell Phone Number:
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Authorized Signer on Behalf of Company?
Yes
No
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Additional Plan Contact (if Applicable)
Enter Additional Plan Contacts Below
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Additional Contact First Name:
Additional Contact's First Name
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Additional Contact Last Name:
Additional Contact's Last Name
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Additional Contact Email Address:
Additional Contact Email Address:
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Additional Contact Phone Number
Additional Contact Phone Number
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Additional Contact Cell Phone Number:
Additional Contact Cell Phone Number:
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Authorized Signer on Behalf of Company?
Yes
No
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Roles Available:
Payroll Processing
Distributions
Loans
Compliance
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Additional Plan Contact (if Applicable)
Enter Additional Plan Contacts Below
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Additional Contact First Name:
Additional Contact's First Name
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Additional Contact Last Name:
Additional Contact's Last Name
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Additional Contact Email Address:
Additional Contact Email Address:
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Additional Contact Phone Number
Additional Contact Phone Number
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Additional Contact Cell Phone Number:
Additional Contact Cell Phone Number:
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Authorized Signer on Behalf of Company?
Yes
No
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Roles Available:
Payroll Processing
Distributions
Loans
Compliance
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Plan Trustees
Plan Trustees are typically one or more owners or officers of the employer, and are the individual(s) responsible for the proper handling of the 401K related funds/money: *Sending money to be deposited in a timely manner *Providing requested information to the Plan Administrator in a timely manner *Authorizing the distribution of plan benefits to plan participants when permitted *Effective execution of requests by the Plan Administrator
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Plan Trustee #1:
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Trustee First Name:
Trustee First Name
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Trustee Last Name:
Trustee Last Name
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Trustee Email Address:
Trustee Email Address:
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Trustee Phone Number
Trustee Phone Number
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Trustee Cell Phone Number:
Trustee Cell Phone Number:
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Grant Employer Level Web Access?
Yes
No
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Plan Trustee #2: (If Applicable)
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Trustee First Name:
Trustee First Name
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Trustee Last Name:
Trustee Last Name
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Trustee Email Address:
Trustee Email Address:
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Trustee Phone Number
Trustee Phone Number
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Trustee Cell Phone Number:
Trustee Cell Phone Number:
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Grant Employer Level Web Access?
Yes
No
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Field is required!
Plan Trustee #3: (If Applicable)
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Trustee First Name:
Trustee First Name
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Trustee Last Name:
Trustee Last Name
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Trustee Email Address:
Trustee Email Address:
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Trustee Phone Number
Trustee Phone Number
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Trustee Cell Phone Number:
Trustee Cell Phone Number:
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Grant Employer Level Web Access?
Yes
No
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Additional Service Provider Contact (e.g. CPA, Attorney, Payroll Provider, etc)
NOTE: Providing this additional contact information is optional
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Type of Provider:
CPA, Attorney, Payroll, etc.
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Contact Company Name:
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Contact First Name:
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Contact Last Name:
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Contact Address:
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Contact City:
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Contact State:
- select a state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
- select a state -
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Contact Zip Code:
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Contact Phone Number:
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Contact Cell Phone Number:
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Contact Email Address:
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Do you have an existing 401K plan right now?
Yes
No
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Enter information for your Current / Existing Recordkeeper (i.e. the investment recordkeeper that will be replaced)
Ask us any questions...
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Existing 401K Recordkeeper:
Existing 401K Recordkeeper
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Recordkeeper Contact Person:
Name of person to contact
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Contact Person Email:
Email address of person to contact
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Contact Person Phone:
Phone number of person to contact
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Recordkeeper Address:
Recordkeeper Address
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Recordkeeper City:
Recordkeeper City
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Recordkeeper State:
- select a state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
- select a state -
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Recordkeeper Zip Code:
Recordkeeper Zip Code
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[{"field":"{existing}","logic":"equal","value":"Yes","and_method":"","field_and":"","logic_and":"","value_and":""}]
Enter information for your Current / Existing Third Part Administrator (i.e. the investment Third Part Administrator (TPA) that will be replaced)
Ask us any questions...
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Existing 401K Third Party Administrator:
Existing 401K TPA
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Existing 401K Third Party Administrator:
Existing 401K TPA
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TPA Contact Person:
Name of person to contact
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Contact Person Email:
Email address of person to contact
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Contact Person Phone:
Phone number of person to contact
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TPA Address:
TPA Address
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TPA City:
TPA City
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TPA State:
- select a state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
- select a state -
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TPA Zip Code:
TPA Zip Code
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[{"field":"{existing}","logic":"equal","value":"Yes","and_method":"","field_and":"","logic_and":"","value_and":""}]
Comments & Instructions for us:
Ask us any questions...
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Signature:
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