Your Personal Legal Name (as it appears on your government ID)

Your E-mail Address

Phone Number

Self-Employed Business Name (if sole proprietor, enter your name)

Your type of Self-Employed Business (C Corp., S Corp., Sole Proprietor, LLC, etc.); if LLC list tax status election- for example, is it taxed as Sole Prop., S Corp. or Partnership; if Corporation, list whether taxed as S Corp. or C Corp.

Last day of your business taxable year (e.g., 12/31; 3/31)

Do you have any full-time employees other than yourself or spouse/business partner? (If -YES, please contact us for more information.)

Will your spouse or business partner also contribute to the Solo 401k? If yes, type "YES" and list his or her name. If he or she wants to be added to the plan as "Co-Trustee" only and will not contribute, type "Co-Trustee only" and LIST his or her NAME. MAKE SURE TO LIST NAME We can also add your spouse or business partner as a co-trustee at a later date.

Are you currently participating in a self-employed 401K? If Yes, please provide the name of the financial institution currently holding the plan AND enter the original effective date of the plan (this is REQUIRED) as we will need to list it on the new solo 401k plan documents.

Will you be transferring existing IRAs (note that a ROTH IRA cannot be transferred to a Roth Solo 401k-this is an IRS rule) or qualified plans such as a former employer 401k to this new Solo 401k? If yes, please list type(s) and name of financial institution(s) where they are currently held. If no, enter no.

Your full mailing address, and or business full address.

Provide the name that you would like to assign to your new solo 401k trust. For example, if you are a sole proprietor or a contractor, a common method of naming a solo 401k is to to use a fictitious name followed by "Trust." For example, "Media Street Trust." Alternatively, if you have a business name, the whole or the first two parts of the business name is commonly used followed by "Trust." 1.DO NOT PROVIDE ACRONYMS OR LLC. 2. DO NOT INCLUDE THE WORD "FAMILY" AS A SOLO 4O1K IS NOT A FAMILY TRUST. 3. THE NAME MUST CONTAIN TWO WORDS PLUS THE WORD "TRUST." (plan names is a total of 3 words) 4. DO NOT USE YOUR FIRST NAME.