Open a 401k Business Financing Plan

Client Information

Note: The person listed above will serve as the Incorporator of the new corporation. The e-mail address provided above may be used by the Secretary of State to send annual renewal reminders and other important notices that may require action or response regarding your corporation.

Corporation Board of Directors and Officers

Note: In most states, you can serve in all capacities (we will let you know if you can't). If you list someone other than yourself as the director, please include such person's address.

Provide desired corporation name and alternative name if the first preference is not available.

Note: The corporation name must include one of the following words or abbreviations: Corporation, Incorporated, Limited Corp., Inc. or Ltd. The word “Company” may not be preceded by the word “and” or a symbol denoting it, such as “&.”

Corporation's Primary Address:

Note: It must be a specific address in the state where the Corporation being registered and cannot be a post office box. Please include the County.

Please provide the name of the corporation’s registered agent and the corporation’s registered office:

Note: You can serve as the resident agent if you have an address in the state where the business will be located. If you list someone other than yourself as the resident agent, you confirm that such person has consented to act as the resident agent of the corporation.

Retirement Account Information

 Yes No

Please list the information of all individuals that will be using retirement funds to finance the corporation:

 Full Partial

 401(a) 401(k) 403(b) 457 DBP ESOP KEOGH Annuity QRP REIT IRRA FERS/CRS IRA Roth IRA SEP IRA Roth Annuity SIMPLE IRA Variable Annuity Thrift Savings Plan

 Full Partial

 401(a) 401(k) 403(b) 457 DBP ESOP KEOGH Annuity QRP REIT IRRA FERS/CRS IRA Roth IRA SEP IRA Roth Annuity SIMPLE IRA Variable Annuity Thrift Savings Plan

 Full Partial

 I have confirmed with my custodian that my funds can be transferred and I acknowledge that I am ultimately responsible for ensuring that my funds are eligible for transfer/rollover into this new 401k plan.

Non-Retirement Funds: Please list all parties investing personal funds in your Corporation

401(k) Plan Mailing Address

 Client Address Corporate Address Corporate Mailing Address Other

Proposed Transaction

 Yes No

 Yes No

 Yes No

 Yes No

 Yes No

Related Businesses

 Yes No

If yes, please provide information on each business or entity below. Please let us know if you have more than three businesses to identify.

#1 Currently Owned Business

 Yes No

 Yes No

#2 Currently Owned Business

 Yes No

 Yes No

#3 Currently Owned Business

 Yes No

 Yes No

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