Name of Company:
Street Address:
City:
State:
Zip:
Main Contact / Decision Maker:
Business Structure:
C-Corp S-Corp Partnership LLC Sole Proprietorship
Fiscal Year:
Plan Year:
Number of Eligible Employees: (Estimate if this is a new plan)
Number of Participants: (If this is a take over plan)
Current Plan Assets: (If this is a take over plan)
Estimated Annual Deposits: (Estimate if this is a new plan)
Surrender Charge: (If this is a take over plan)
Plan Type:
401(k) Profit Sharing Profit Sharing ERISA 403(b) Defined Benefit Money Purchase ESOP Other
Are contributions directed by employer or employee?
Desired Broker Compensation: (Or Call your BEI Representative for Assistance)
If this is a take over plan:
Who currently provides Plan Administration?
Who currently provides Recordkeeping Services?
Investment Professional Information:
Your Name:
Firm's Name:
Street Address:
City:
State:
Zip:
Phone:
Email:
Comments: