Authorization Form

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OFFICE USE
AUTHORIZATION FORM
PS
401k
DB
DB/DC
Proposal
NPC Initial Admin
New Plan Takeover Doc Only
1 SPD
Consultant
Administrator
Employer
Official Address
County
Main (____)
Shipping Address
Fax
(____)
E-mail
Contact Person
Direct (____)
Business Code
Date Business Commenced
EIN #
Trust #
Fiscal Year End
Plan Year End
Entity Type:
Corporation
S Corporation
Sole Proprietor
Partnership
LLC
(taxed: Corp/ Partnership/ Sole Prop) 
Other:
Accountant
Phone (____)
Fax
(____)
E-mail
Inv. Advisor
Phone (____)
Fax
(____)
E-mail
Financial Institution
President
Secretary
Vice President
Treasurer
Board of Directors
Stockholders/Owners
Percent
PLAN & TRUST
Plan Name
Trustee
Plan Effective Date
Resolution Date
Provisions Effective Date
IRS Plan #
1

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Parent category: Business
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