Proposal Request
  Please complete the following form to the best of your ability. The information you provide will assist us in determining what type of program would be best for you and your employees.
Proposal Requested By:
First Name:
Last Name:

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Company Name:
Phone Number :
Address1:
Address2:
City:
State:
Zip Code:
E-mail Address:
Website:
Is this a new or existing plan? New   Existing Plan
How many employees are expected to participate in this plan?
What are the expected annual deposits to the plan? $
If this is an existing plan, what will the approximate transfer amount be? $
What type of plan(s) are you interested in/do you currently have?
(check all that apply)
401k & Profit Sharing Simple 401k Plan
Profit Sharing Plan Money Purchase Plan
Safe Harbor 401k Plan
Does/will the plan allow for participant loans? Yes   No   I'm not sure.
Is the Employer part of a commonly controlled group or affiliated service organization as described in 414(b), 414(c), 414(m)? Yes   No   I'm not sure.
If this is an existing plan, who is the current plan provider?
If this is an existing plan, are there any problems with the current plan? Yes   No
If yes, please explain:
Any additional information that would be helpful?
How did you hear about Midwest Group Benefits?
Referred by a current MGB Client
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Other