401(k) Information Request

Thank you for your interest.

By far the most common employer-sponsored retirement plan is the 401(k) plan.
The 401(k) plan is a defined contribution plan. It allows employees to make pre-tax contributions, and the funds contributed plus any earnings accumulate tax deferred.

After completing the form, please click on the "Submit" button. Your information will be emailed to our offices and we will process your request. All information will be kept confidential.

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Contact Information

» Full Name:

Address:

City:

State:

Zip:

» Phone:

» Email Address:

401(k) Plan Information

When would you plan on implementing your new 401(k) plan?

During the next month
Within three months
Before the end of the year

How many employees would be eligible for the 401(k) plan?

What percentage of eligible employees would you expect to participate?

Investment Options

What types of investment vehicles would you like to offer eligible employees?

Mutual Funds
Self-Directed Brokerage Account
Need more information to decide

Do you plan on matching any portion of the employee contribution?

Yes No

Please note any special features or options you would like to offer as part of your new 401(k) plan.

These quotes do not guarantee coverage and
actual premiums may differ from the quotes provided

Chapman-Cornelius Insurance Services, Inc.

2009 E. Lamar Blvd. Ste 200

Arlington, TX 76006

Phone: 817-265-3346 • 800-880-4696

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Fax: 817-265-3386

www.chapman-cornelius.com

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info@chapman-cornelius.com

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