Proposal Request Form

Name of Client:

Type of Plan: 
    401(k) Plan
    Profit Sharing Plan
    Defined Benefit Plan
    Other:

New or Takeover? (please select one) New Takeover

Anticipated Start Date of Takeover:

Number of Employees:                                    Number of Participants:

Assets in Plan: $    

Where are assets currently?

Where are assets moving to? (if applicable)

Proposed Changes to plan (if any):

Corporate Trustee? Yes No                          Is employer stock available in the plan? Yes No

Broker Name:

Broker Firm:

Phone:                                                Fax:

email:

Mailing address:

Number of Proposals Needed:                    Date Proposals Needed By: