Requested By Phone Number E-mail Address

If this is your first time requesting a proposal, please complete the information below:

Your Firm Name: Your Firm Fax: Your phone number

Employer / Plan Information

Legal Name of Employer: Legal Plan Name: Address: City: State: Zip:
New Plan or Takeover : Select New Take Over

Approximate Number of Eligible Employees:
Plan Type : Select 401 ( K ) Safe Harbor 401 ( K ) Cross - Tested Solo ( K ) Profit Sharing Money Purchases

If Takeover, Please Complete the Following:

Current Investment Institution: Estimated Conversion Assets: Amount of Recurring Deposits: Effective Date of Plan (as on Adoption Agreement - mm/dd/yy): Plan Year End (mm/dd):

Notes / Special Instructions

Please complete this census and send it back to our office
via email to admin@s1services.com with the subject line “Proposal Request.”