Retirement Plans

Referral Source Name: *  

Company Name:

Street Address:

City: *  

State: *  

Zip:

Phone: *  

E-mail: *  

Preferred Contact Method: --Select One-- Phone E-mail

Client (Company) Name: *  

Contact Name:

Street Address:

City: *  

State: *  

Zip:

Phone: *  

E-mail: *  

Preferred Contact Method: --Select One-- Phone E-mail

Client's Employer Identification Number:

Business Year End:

Type of Business: --Select One-- Sole Proprietor Partnership LLP Corporation LLC S-Corporation

Do owners, spouse or minor children own part of any other business? --Select One-- Yes No

Is this company a subsidiary of any other company? --Select One-- Yes No

Do/will any union employees participate in the plan? --Select One-- Yes No

Note: If you answered "Yes" to any of the above please explain here:

Type of Plan Desired: --Select One-- Defined Benefit Profit Sharing 401(k) 403(b) Prevailing Wage

If 401(k) plan, does the employer wish to make matching contributions? --Select One-- Yes No

Does the employer wish to make discretionary profit sharing contributions? --Select One-- Yes No

The goal of the plan is to:

The client currently sponsors the following plan(s): NONE
Defined Benefit
Profit Sharing
Money Purchase
401(k)
403(b)
Simple IRA
SEPP
Other:

If a census is available, please attach here (Excel format is preferable):

If you are already working with a Polycomp Pension Consultant, please indicate so here: --Select One-- Amanda Asherson, APR / Woodland Hills, CA Aaron Karr, APA / Roseville, CA Bridget Powers / Roseville, CA Scott Ann Setzer / San Diego, CA