You must have JavaScript enabled to use this form. Basic Employer (Plan Sponsor) Information Name of Adopting Employer Employer Identification Number Business Address Street Address Suite or Unit City/Town State - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP Date Business Started Phone Number Plan Contact Information Name of Plan Contact Plan Contact Email Phone Number Business Information Type of 401(k) Plan requested - Select - Traditional 401(k) Plan Profit Sharing Plan Automatic 401(k) Safe Harbor 401(k) Solo 401(k) Plan Is this a new plan? Yes No Business Entity - Select - C Corporation S Corporation Non-Profit Partnership Limited Liability Company Sole Proprietorship Total number of employees Do you own more than one business? Yes No