ReSure Express Checkbook Solo 401k ApplicationWelcome to ReSure Express Checkbook Solo k! A Checkbook Solo 401k is a 401k plan sponsored by a business that has no eligible 401k plan participants other than the business owner(s) and/or their spouse(s). Your full legal first and last names(Required)Your full legal first and last names, as they appear on government issued ID First Last Email(Required)Please use the same email address across all ReSure platforms Phone(Required)Your phone #Address(Required)Please use an actual physical address, not a PO Box. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Existing 401k Plan Info, if applicableNew 401k plan or restatement of a pre-existing plan?(Required)Is this a new 401k plan or restatement of an existing plan previously adopted by your business? New 401k Plan Restatement Pre-exiting 401k Plan NameExisting 401k Plan Effective DateEnter the effective date the pre-existing 401k Plan that is being restated. This is usually either the date the plan was documents were signed or January 1 of that year.Pre-exiting 401k Plan EINIf the pre-existing plan has its own EIN, please enter it. It is possible that the plan does not have its own EIN, especially if its only investments were publicly traded securities. Business InfoBusiness Legal Name(Required)Business Legal Name, including the appropriate designator, if applicable (e.g., LLC, Inc, etc.). If sole proprietorship, enter your full legal name.State of Business Formation(Required)State of Formation for business legal entity. For Sole Proprietorship, enter the state in which you reside.AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of Formation(Required)Date of Formation, such as the date you started doing business or the date Articles of Organization/Incorporation were filed MM slash DD slash YYYY Business Legal Structure(Required)Select your business legal structure from the choices below.Sole Proprietorship (no entity)Partnership (no entity)Single-Member LLCMulti-Member LLCCorporationBusiness Industry(Required)Please select the option that best describes your business activity.Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherBusiness Tax Structure(Required)Select your business tax structure from the choices belowSole ProprietorshipDisregarded EntityPartnershipS-CorpC-CorpBusiness EIN(Required)Your business EIN, not your SSN.Fiscal Year End(Required)The last day of your business taxable year. For most businesses, this is 12/31. If you're unsure about fiscal year end, it's most likely 12/31 (but you may want to confirm with your accountant). MM slash DD slash YYYY Express Checkbook 401k One-Time Setup Fee(Required) Price: Express Checkbook 401k Recurring Fee(Required) Price: Credit CardCard Details Cardholder Name Consent to Authorization and Terms and Conditions(Required) I agree to the Authorization and Terms and ConditionsBy checking the box you represent that you have self-employment activity but no full-time non-owner W-2 employees and that all the information provided is true and accurate. You authorize the creation of your 401k documents and authorize that an EIN be obtained on your behalf. You hereby make, constitute and appoint ReSure LLC as your attorney-in-fact to act separately in your name, place and stead in any way which you could do if you were personally present, to the extent that you are permitted by law to act through an agent, to obtain a new tax ID number for your Solo QRP trust. This power of attorney, however, shall terminate 90 days from the date of execution or upon written revocation whichever shall occur first. You, for yourself and your heirs, executors, legal representatives and assigns, hereby agree to indemnify and hold ReSure harmless from and against any and all claims that may arise against ReSure by reason of ReSure having relied upon the provisions of this power of attorney. Plan maintenance, such as amendments or restatements required to maintain the plan’s qualified status with the IRS, are provided by subscription as outlined in Payments Authorization, below. Failure to pay invoices due and termination of services by ReSure LLC may result in disqualification of your Qualified Plan and/or revocation of your right to use the ReSure-supplied documents. The persons identified in the form entries will be acting as plan administrator(s), trustee(s), and fiduciaries. All actions and decisions on behalf of the plan and its assets are the responsibility of such persons. ReSure LLC, its management, and related companies are not acting as investment advisors, plan administrators, trustees, or fiduciaries to the plan. Any information provided by ReSure LLC is not intended to be a substitute for professional advice from an accountant, attorney, or tax preparer. It is agreed that ReSure’s responsibility for damages, or claims of damage, arising from any form of action, other than gross negligence, shall not exceed the total amount paid for the services invoiced. This shall be the exclusive remedy. Either party may bring no action, regardless of form, arising out of the services under this agreement, more than one year after the date of the last service provided under this agreement. The laws and jurisdiction of the state of New York shall govern any and all matters related to this agreement.Consent to Maintenance Auto-Charge(Required) I agree to have initial and recurring fees be charged to my credit card.This agreement may be canceled by either party at any time, at which point subsequent billings will cease.Solo Business Representation(Required) I represent that I have a business that is eligible to adopt a 401k plan and that the 401k plan will be a "Solo 401k," with no eligible participants other than business owner(s) and their spouse(s).Signature(Required)Typing Your Name Below Constitutes a Legally Binding Signature
