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FBi Plan Profile Request Form
ADVISOR INFORMATION
Advisor Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Advisor Email
*
Advisor Firm
*
Advisor Logo Included (if yes please send logo file)
Yes
No
PLAN INFORMATION
Company Name
*
Plan Name
Industry Code (from 5500) optional
Recordkeeper
*
Name of TPA (if any)
Is the Plan Currently Advisor/Consultant Supported
*
Yes
No
Name of Current Advisor/Consultant Firm (if any)
Plan Entity Type
*
Single Employer
Multi-Employer
Multiple Employer
Retirement Plan Type
*
401k
Profit Sharing
Defined Benefit
Cash Balance
403(b)
457
Company Stock
Self Directed Accounts
Plan Assets
*
Number of Participants with Balance
*
Notes
Please list any plan exceptions like if there is company stock or self directed accounts, or any data that may impact the overall cost to administer the plan. These should be highlighted when showing the plan sponsor the plan fee benchmark report.
5500 Form (if available)
Phone
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