This optional form is for opening a Company 401k plan with 401kBrokers.com. This is not a secure form at this time, but there are no required fields, so insert whatever information you care to share and we will follow up for anything missing. We are working towards making this form secure. If you do not want to use this form, click your browser's back button and go to our forms page. You may complete the application paperwork found there and mail, fax or overnight the paperwork to our office located at 1205 Prospect Street, Suite 400, La Jolla, CA 92037-3612. For any questions, please call us at 800-474-3826.

This form is for opening a Company 401k plan only. (We define a Company 401k plan as a 401k plan sponsored by a Company with any employees (other than just a business owner and/or their spouse) over the age of 21 who work more than 1,000 hours a year. If you want to open a Solo 401k plan, click your browser's back button and go to our apply online page for online enrollment of a Solo 401k plan.

To enroll online for a Company 401k, complete and submit the following information:

Company information

Company Name: (if you do not have a Company name, use your own name)

Company EIN: (if you do not have a Company EIN, use your SS# or leave blank)

Company Phone number:

Type of entity: Sole Proprietorship Corporation S-Corporation LLC-single member disregarded entity LLC-taxed as a partnership LLC-taxed as a corporation

Number of company owners:

Account information

Is this a new plan or an existing 401k plan? New 401k Plan Existing 401k plan If this is a new plan you will need to complete and submit a plan design questionnaire. If this is an existing plan, you will need to submit a copy of your 401k plan document, trust adoption agreement, summary plan description and current company census.

Number of company employees who work more than 1,000 hours a year:

Number of 401k eligible employees: (approximately)

Number of 401k participants: (if known)

What date would you like the 401k plan to begin? You can make the effective date no earlier than the first day of the calendar year in which you sign the trust adoption agreement. Employee salary deferrals may only be made from compensation earned after adoption of the plan.

Type of Account

Do you want pre-tax 401k accounts for your employees? Yes No Do not know (Contributions are tax deductible when made and distributions are taxed when taken out. Treasury regulations require you to at least offer pre-tax accounts to your eligible employees if you are offering a 401k plan. ROTH after tax accounts are optional).

Do you also want ROTH after-tax 401k accounts for your employees? Yes No Do not know (Contributions are not tax deductible when made and distributions are not taxed when taken out) Click here to learn more about ROTH 401k accounts

Has the company listed above previously sponsored a qualified retirement plan? Yes No Do not know

If yes, what type of qualified retirement plan have your previously sponsored? No prior plans Keogh Money purchase pension plan 401k SEP-IRA SIMPLE IRA Defined Benefit Plan

Trustee information (The Trustee(s) are in charge of the 401k plan. You do not need to have a Co-trustee. Trustees and Co-Trustees do not need to also be participants)

Trustee full name:           

Trustee phone number:

Trustee email address: 

Co-Trustee information

Co-Trustee #1 full name:        

Co-Trustee #1 phone number:

Co-trustee #1 email address:  

Physical Address Information

Physical street address: This can be your business or work street address but it must be a physical street address (not a P.O. Box)

Physical address city:   

Physical address state: 

Physical address zip:    

Check here if your mailing address is the same as your physical address:

Mailing Address Information

Mailing street address: (This can be a P.O. Box)

Mailing address city:   

Mailing address state: 

Mailing address zip:    

Participant information

Please provide us with a census of all full time employees (1,000 hours a year or more) including their name, date of birth, social security number, hours worked, hire date, termination date, (if applicable), ownership percentage, last year's compensation, and this year's total annual compensation. You may provide this information in any format that is convenient to you, including emailing us an excel spreadsheet.

Custodian of assets (The custodian of assets is typically a brokerage house or fund company that holds your 401k investments and money and provides you with investment choices) You may select almost any custodian that can accommodate a trust account administered by a third party. The administrative fees we charge do not vary by custodian and we do not receive any fees from any of the custodians. As a result, we are neutral with respect to which custodian you choose. We do not hold your money and we have no access to your money. You will have direct telephone and online access to your 401k account(s) at the "Custodian" of your choosing.

The 401k account(s) will be custodied at: Vanguard TD Ameritrade TD Ameritrade Institutional Fidelity E*Trade Charles Schwab Other Custodian

Payment of our administrative fees

401kAdministrators, our wholly owned subsidiary, shall receive an annual fee equal to one-quarter of one percent (¼ of one percent) of the total plan assets. The administrative fee is pro rated, assessed quarterly and subject to change by 401k Administrators upon written notice to the Plan Sponsor at least 3 months in advance. You must select a method of payment for the administrative services. You may pay by automatic bank transfer, by credit card or by PayPal.

Please choose one of the following methods of payment:

You will not be billed at this time. You will not be billed until your account is open and funded and after the close of the calendar year quarter. Plan sponsor agrees to pay administrative fees by Please select one American Express Bank draft Discover Mastercard PayPal Visa You may also download a fee payment election form here and fax it or mail it to us in lieu of providing the information below.

Bank Draft

Insert your bank account number:    

Insert your bank routing number:     

(Your bank routing number is is the 9 digits on the lower left of your check between the |: symbols |:. Do not use the routing number from a deposit slip.)

Credit Card

Credit Card number:               

Credit Expiration date:             (i.e. "10/08")

Credit Card Security Code:     (3 extra digits found on the reverse of your card for Visa, Mastercard & Discover and 4 digits on the front for American Express)

PayPal

Insert your PayPal email billing address here: