Simpkins & Associates

Plan Information
	Company Name:
	Entity Type:	C Corp S Corp Multi-Employer Other
	Contact Name
	Contact Phone:
	Estimated Transferred Assets:
	Estimated Annual Contributions:
	Number of Eligible Employees:
	Number of Current Participants:
	Proposed Financial institution:	Nationwide ING John Hancock Transamerica
	Name of Specific Product:
	Type Of Plan: (Check all that apply)	401(k) w/ match 401(k) w/o match Profit Sharing 403(b) w/ New Comparability w/ Safe Harbor
	Would you like to show any of the following options?	Money Manager Trustee Services Self-Directed Brokerage Other (Call to discuss)
Existing Vendor/Provider
	Vendor / Provider Name:
	Existing Recordkeeper / TPA:
Broker / Advisor Information
	Complete Name:
	Address
	City, State, Zip	, AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
	Agency Name:
	B/D Affiliation
		Series 6Series 7N/A
	Compensation:
	Phone:
	Email:
	Proposal Copies: (default is 1)
	Date Needed: (allow for mail)