401K Employer Application
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Company Name:
Company Name
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Required Field
Company EIN (no dashes)
EIN
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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
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Required Field
City:
City
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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
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Primary Plan Contact
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?
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Additional Plan Contact (if Applicable)
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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?
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Roles Available:
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Additional Plan Contact (if Applicable)
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Additional Contact First Name:
Additional Contact's First Name
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Field is required!
Additional Contact Last Name:
Additional Contact's Last Name
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Field is required!
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?
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Roles Available:
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Plan Trustees
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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?
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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?
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Plan Trustee #3: (If Applicable)
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Trustee First Name:
Trustee First Name
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Field is required!
Trustee Last Name:
Trustee Last Name
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Field is required!
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?
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Additional Service Provider Contact (e.g. CPA, Attorney, Payroll Provider, etc)
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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?
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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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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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Comments & Instructions for us:
Ask us any questions...
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Signature:
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