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Please complete as much information as possible so that we may begin to setup your plan.
Name of Company
*
Company Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Fed Tax ID#:
*
Type of Business Organization:
*
Regular Corporation
S Corporation
Self-Employed
Affiliated Service
Partnership
Limited Liability Company, taxed as a:
Partnership
Corporation
Sub-S Corporation
Fiscal Year End of Company:
*
Is the company a member of a controlled group of corporation, under common control, or an affiliated service group?
Primary Contact Name
*
First
Last
Email of Primary Contact:
*
Name of Trustee(s):
Trustee's Email Address:
Plan Name (if not a startup):
Fidelity Bond Company
(Trustees are required to be bonded for at least 10% of plan assets)
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