NEW PLAN ORDER FORM
for companies with no previously established 401k plan or other company retirement plan
1.Will this be your company's first 401k plan, or are you replacing an already-existing plan? First 401k plan
Already-existing 401k plan to be converted to a Small Employer 401k plan (STOP!!! Please use our Conversion Plan Order Form instead of this New Plan Order Form if your company already has a 401k plan. Thank You.)
2.Company name
3.Contact person
4.Title
5.Phone
 - 
6.Fax
 - 
7.E-mail
8.Your 401k decision-making role Sole decision maker
Making recommendation
Leading committee to gather information
Member of committee to evaluate options
Interested employee
Unsure. Please contact me with help regarding this item.
9.Company address
10.City
11.State
Zip Code
12.Company mail-to address
Use address listed above as mail-to address
Use other address
13.Federal ID Number
14.Date business commenced
15.Type of entity Please indicate your company's type:
C Corporation
Professional Service Corporation
S Corporation
Limited Liability Company taxed as (check one)...
Partnership or Sole Proprietorship
Corporation
S Corporation
Sole Proprietorship
Partnership
Other:    

Is your company a member of a controlled group?

Yes No Unsure. Please contact me regarding this question.

Is your company a member of an affiliated service group?

Yes No Unsure. Please contact me regarding this question.
16.# of employees on payroll
17.Fiscal year on which business is run
18.Computer system

PART II: PLAN INFORMATION...
Note: Complete the below ONLY if the Small Employer 401k plan will be your company's FIRST retirement plan ever.
If your company already has a retirement plan and will be having Small Employer 401k replace that plan, please use our Conversion Plan Order Form instead of this New Plan Order Form. Thank You.
19. Potential size, in number of employees, of your Small Employer 401k plan: Number of full-time employees currently on your payroll:
2 - 4
5 - 10
11 - 15
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
more than 50
Unsure. Please contact me regarding this item.
20. Plan Administrator: Most Small Employer 401k customers name their company as their official 401k Plan Administrator, though you do have the option of designating an outside party to handle your 401k plan administration via Small Employer 401k.

Who will serve as Plan Administrator for your Small Employer 401k plan? If you don't know, mark the "Unsure. Please contact..." box.
Our company:
Have our employees contact (name, title) by calling or e-mailing when need be.
Outside party:
Contact (name, title) of (company name) ; tax ID number is ; phone number is , e-mail address is , mailing address is (including city, state and zip) .
Unsure. Please contact us about naming a Plan Administrator.
21. Plan Trustee(s): Who at your company will serve as your Small Employer 401k plan's Trustee(s)? Please include his/her/their title(s) (such as "CFO"), as applicable. If you are unsure who will serve as your plan's trustee(s), mark the "Unsure. Please contact..." box below.
Trustee(s) phone number(s):
Unsure. Please contact us about naming a Plan Administrator.
22. Compliance test preferences: (remember, just mark "Unsure" if you want help with any item; compliance test preferences is something people new to 401k plans usually need help with) You have some flexibility regarding the parameters by which the IRS compliance tests your plan will have to pass each year are run. Your Small Employer 401k software will have your preferences hardwired into it so you can run accurate compliance tests as often as you like (we recommend monthly). Small Employer 401k will keep you apprised of your plan's health and help ensure your plan passes its critical year-end tests.

The determination of Highly-Compensated versus Non-Highly-Compensated Employees for your plan will be based on the previous year's wages. Would you like your plan to limit the definition of Highly-Compensated Employees to "the top 20% of employee"?

Not applicable: Safe harbor plan
Yes (recommended)
No
Unsure. Please contact me regarding this item.
23. Age requirement for participation in Small Employer 401k plan: What age requirement do you want for your Small Employer 401k plan?
None
21
Other (please specify):
Unsure. Please contact me regarding this item.
24. Length of Service requirement for your Small Employer 401k plan? What length of service requirement do you want for participation in your Small Employer 401k plan?
None
Three (3) months of service with the company
Six (6) months of service with the company
One (1) year of service with the company
Other (please specify):
Unsure. Please contact me regarding our Small Employer 401k plan length of service requirement.
25. Participation exclusions: Would you like to exclude any categories of employees from participation in your Small Employer 401k plan?
Yes
No
Unsure. Please contact me regarding participation exclusions used in our existing company plan.

If "Yes", please identify the classes of employees you'd like to exclude from participation in your Small Employer 401k plan: (check all that apply)
Union members
Non-resident aliens
26. Automatic enrollment: Do you want your Small Employer 401k plan to use automatic enrollment?
Yes No Unsure. Please contact me regarding this item.

If "Yes", what would you like the default contribution rate to be for automatically enrolled participants?
Not applicable. Do not want auto enrollment used in our Small Employer 401k plan.
3% 4% 5%
Unsure. Please contact me regarding using auto enrollment in our Small Employer 401k plan.
27. Employer contributions: If you plan to run your 401k as a safe harbor plan, please indicate any relevant safe harbor employer contributions at item 32 of this order form and DO NOT include your safe harbor contribution formula(s) herein under item 27 Employer Contributions.
(click for more information)		 Your company can contribute to plan participants' accounts in any of three ways:
(1) regular matching contributions,
(2) discretionary employer contributions, and/or
(3) qualified nonselective contributions.

Regular matching contributions (RMCs) are defined in terms of participant's elective contribution (e.g., 50¢ contributed by the employer for each dollar contributed by the plan participant). Discretionary employer contributions (DECs) are basically profit-sharing contributions, although the employer's contribution does not have to be limited to net profits. Qualified nonselective contributions (QNECs) are allocated on the basis of compensation or some other variable aside from a participant's elective contribution; they are made to ALL eligible employees regardless of whether or not the employee contributes to or participates in the 401k plan — unless the QNEC is being used to satisfy ADP or ACP test corrections. As for vesting, RMCs and DECs can be subject to vesting schedules, but QNECs are always 100% vested to employees' accounts when made.

1) Will your company be making any REGULAR MATCHING CONTRIBUTIONS to employees' accounts?
No regular matching contributions will be made.
Our company MAY make matching contributions equal to a discretionary percentage that our company will determine at a later time.
Our company WILL make regular matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan.
Our company WILL make regular matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan, up to a maximum annual matching contribution of (check and complete one):
$ per participant per year.
  % of the participant's compensation per year.
a discretionary percentage of the participant's compensation or a discretionary dollar amount, the percentage or dollar amount to be determined by our company on a uniform basis to all participants.
AND our company (check one) will will not contribute an additional discretionary percentage, to be determined by our company.
Other:
  
Unsure. Please contact me regarding regular matching contributions.
2) Would your company like to have the option of being able to make DISCRETIONARY EMPLOYER CONTRIBUTIONS (i.e., profit-sharing contributions) to employees' accounts?
No, we do not want the option of even possibly making profit-sharing contributions.
Yes, our company will POSSIBLY make profit-sharing contributions in an amount to be determined by our company. AND DOES NOT want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)
Yes, our company will POSSIBLY make profit-sharing contributions in an amount to be determined by our company AND DOES want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)
Unsure. Please contact me regarding profit-sharing contributions
3) Would your company like to have the option of being able to make QUALIFIED NONSELECTIVE CONTRIBUTIONS to employees' accounts?
No (except as needed for discrimination test corrections).
Yes, our company will POSSIBLY make qualified nonselective contributions in an amount to be determined by our company. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)
Yes, our company will make qualified nonselective contributions equal to % of the total compensation of all participants eligible to share in the allocations.
Unsure. Please contact me regarding profit-sharing contributions.
28. Vesting of employer contributions: "Vesting" refers to ownership. For instance, if you pick Schedule D below and a plan participant leaves your company after 2 years, he or she will only be entitled to 20% of any relevant employer contributions made by your company to his or her account. The remainder will go into a pool that your company can choose to use for employer contributions owed to other participants.

What vesting formula do you want to use for any employer contributions? Mark your choice for any profit-sharing contributions in column P-S Contrib and for any matching contributions in column Match Contrib.

P-S Contrib Match Contrib Vesting Schedules
Not applicable (no employer contributions, so no vesting)
SCHEDULE A: 100% immediate vesting
SCHEDULE B: 0-2 years
3 years		 =
=		 0% vested
100% vested
SCHEDULE C:
WARNING: not recommended due to likelihood of causing top heavy testing problems.		 0-4 years
5 years		 =
=		 0% vested
100% vested
SCHEDULE D: 0-1 years
2 years
3 years
4 years
5 years
6 years		 =
=
=
=
=
=		 0% vested
20% vested
40% vested
60% vested
80% vested
100% vested
SCHEDULE E: 1 year
2 year
3 year
4 year 		=
=
=
=
 25% vested
50% vested
75% vested
100% vested
SCHEDULE F: 1 year
2 year
3 year
4 year
5 year
 =
=
=
=
=		 20% vested
40% vested
60% vested
80% vested
100% vested
Other:
Unsure. Please contact me regarding the vesting schedule(s) to use for
   our 401k plan.
29. Loans: Do you want your Small Employer 401k plan to allow for 401k loans (that is, for participants to borrow from their accounts)?
(click for more information)
Yes
No
Unsure. Please contact me regarding this item.
30. Investments:
INVESTMENT TYPE
(view investment listings)		 Please indicate the type of investments you want for your Small Employer 401k plan: (click for a pop-up window about your Small Employer 401k investment options)
Self-Directed Brokerage Accounts only
No-Load Mutual Funds only
Load Mutual Funds only
Unsure. Please contact me regarding the type of investments to offer within our Small Employer 401k plan.
31. Investments:
INVESTMENT FAMILY
(view investment listings)		 Please indicate the family of mutual funds and/or the brokerage account you wish to offer within your Small Employer 401k plan (for example, T. Rowe Price mutual funds or Charles Schwab One Source brokerage accounts). If you have not already done so, you should look through our investment listings to view your options — or simply contact us for help by clicking the "Unsure..." button below.


Unsure. Please contact me regarding the exact investment family and/or brokerage account to offer within our Small Employer 401k plan.
32. Safe Harbor Designations:
The IRS allows 401k plan sponsors an alternative to subjecting their 401k plans to annual discrimination testing. The safe harbor method of plan operation lets employers instead make certain contributions to the plan, with immediate vesting of the contributions to employees' 401k accounts. (click for more information)

Do you want to operate your Small Employer 401k plan as a safe harbor 401k plan?
Yes
No (you can skip the rest of this section 32)
Unsure. Please contact me regarding operating our 401k plan as a safe harbor plan.
If you are choosing to operate your 401k plan as a safe harbor plan, which employer contribution formula would you like to employ?
Not applicable (don't want to use the safe harbor method)
Make a qualified nonselective contribution equal to 3% of compensation to each eligible employee's account. (Note: Qualified nonselective contributions are made to ALL eligible employees accounts, regardless of whether the persons participate in the company 401k plan.)
Make a dollar-for-dollar matching contribution to non-highly-compensated employees on salary deferrals up to 3% of compensation and 50¢ to the dollar matching contributions to non-highly compensated employees on salary deferrals of 3% to 5% of compensation, making sure not to exceed these rates in any matching contributions made to highly compensated employees. (Note: Matching contributions, because they're based upon salary deferral amounts, are made only to currently-participating employees' 401k accounts.)
Unsure. Please contact me regarding the type of 401k safe harbor contribution to make.
If you are choosing to operate your 401k plan as a safe harbor MATCHING CONTRIBUTION plan, how often do you want your employer matching contributions to be made?
Not applicable (don't want to use the safe harbor method)
Annually
Per payroll period
Per month
Per quarter
Unsure. Please contact me regarding the frequency of making our 401k safe harbor employer contributions.
PART III: PURCHASE INFORMATION...
33. The price of your Small Employer 401k system: (Small Employer 401k is licensed on a calendar year basis, which requires the purchase of a new license at the beginning of each calendar year)
PLAN SIZE
(in number of eligible employees)		 ANNUAL FEE
for your custom 401k plan and plan administration system
2-4 eligible employee $695 per year
5-10 eligible employees $895 per year
11-15 eligible employees $995 per year
16-20 eligible employees $1195 per year
21-25 eligible employees $1395 per year
26-30 eligible employees $1595 per year
31-35 eligible employees $1795 per year
36-40 eligible employees $2095 per year
41-45 eligible employees $2295 per year
46-50 eligible employees $2495 per year
more than 50 eligible employees ($2475 plus $245 for each additional 5 eligible employees
34. $695 FIRST-YEAR-ONLY setup fee (Remember, this fee, unlike the above money-back guaranteed Annual Fee, is NONREFUNDABLE but generally tax readable. We encourage prospective clients to try our free Product Demo to make sure they like Small Employer 401k before they have us set up a customized a system for them.)
35. TOTAL (system price + setup fee):
PART IV: PAYMENT PREFERENCE...
36. NO PAYMENT IS DUE AT THIS TIME.
We will contact you within 24 hours of receiving your order to confirm your designations and answer any questions you have.

Do you prefer to be contacted regarding your order by telephone or e-mail?
Contact by phone
Contact by e-mail
37. When your Small Employer 401k representative calls you to go over any items about which you marked "Unsure..." and to collect additional information needed for your plan's official Summary Plan Description (SPD) and Prototype Plan Adoption Agreement, you will be able to pay your Small Employer 401k customization fee using your Visa, MasterCard, American Express Card*, or by check through the mail; there is a five-day holding period on all check orders.

As soon as we receive your payment we will customize your software, prepare official documents for your review, then send out your customized system. You can have your 401k up and running within two weeks - or less.

Please indicate at right your payment preference. (*Note: We do not add credit card processing fees to MasterCard or Visa transactions but do add a $25 processing fee to all American Express transactions.)
credit card* via phone
check
Part V: How did you hear about us?
38. One last thing before you submit your order: Please tell us how your heard about Small Employer 401k...

Financial planning professional, friend or colleague. Please list the person and/or company name:
Linked to the Small Employer 401k web site from another web site. Please tell us the name of the site and/or company sponsoring it:
Web search. Please list the browser and search term(s), if you remember them (e.g., Netscape, 401k software):
Business or trade publication. Please give the name of the publication:
Other. Please explain:
39. Now please look over our User's Agreement, then submit your order or inquiry. (Submitting an order acknowledges that you have read and accept our User's Agreement but in no way obligates you to making any purchase.)
Tell a friend about Small Employer 401kTM.

Become a 401k Referral Partner

Earn $$$ for every company you refer to us that adopts a Small Employer 401k self-service 401k plan.
Contact us to sign up!