Step 1 of 616%IRA ApplicationPersonal InformationTitleMr.Ms.Mrs.Dr.Legal NameDate of Birth Date Format: MM slash DD slash YYYY Social Security NumberLegal/Street AddressLegal/City, State, ZipMailing Address (optional)Mailing/City, State, ZipPrimary PhoneFaxMobileEmail Address Marital Status Single Married (see Consent of Spouse) Widowed or DivorcedOccupationTitleNotificationsWould you like to review your statements online? Yes NoWould you like to receive email notifications of changes to your account? Yes NoAccount TypePlease Select One: Benficiary Inherited IRA Health Savings Account Roth IRA SEP IRA (please attach employer plan documents) Simple IRA (please attach employer plan documents) Traditional IRAEmployer NameEmployer Plan Document UploadEmployer NameEmployer Plan Document UploadCheck One: Trad Roth SEP SimpleOriginal IRA Holder Name:Check One: Self-only coverage Family coverageAccount Funding Annual Contribution Transfer Contribution - Transfer from existing IRA or Employer Sponsored Plan. Rollover Contribution - Take receipt of the assets for up to 60 days before reinvesting in a new retirement plan. Direct Rollover Contribution - Rollover from Employer Sponsored Plan.Year Contributed for:Beneficiaries NameActions EditDelete There are no Beneficiaries. Add Beneficiary Maximum number of beneficiaries reached.Please add a designated beneficiary. If a trust, please provide first and last pages of Trust.Trust Document Upload Drop files here or Accepted file types: pdf, jpg.Transfer FormCurrent IRA Custodian/TrusteeName of Custodian/TrusteeAccount NumberCurrent StatementAccepted file types: pdf, png, jpg, gif.Transfer Department AddressCity, State, ZipContact NamePhone NumberType of Account Traditional Roth SEP Simple HSA ESA 401(k) Beneficiary IRATransfer DetailsHave you confirmed the Non ACAT transfer department address with your custodian? No - Leave blank and we will use our custodial transfer address list Yes - Please send Transfer request to above listed addressTransfer Details Option One: Cash Transfer Option Two: In-Kind Transfer Complete (Liquidate and send all proceeds) Partial - Send Only $: Complete (Send all assets listed below and cash) Partial - Send ONLY the assets listed belowAsset Description Asset Description AmountActions EditDelete There are no Assets. Add Asset Maximum number of assets reached.Transfer InstructionsPlease send cash via: Check Wire ($15)Please send request via: Mail Expedited 2nd Day Delivery ($30)*Default to mail, if uncheckedRollover/Direct RolloverCertification FormCurrent Custodian/TrusteeName of Custodian/TrusteeAccount Number (if applicable)Phone NumberContact NameType of Plan you are rolling over from: Traditional Roth SEP Simple ESA HSA Employer PlanRollover DetailsI am an eligible person to perform this transaction: Plan Participant Spouse beneficiary of account Non-spouse beneficiary of account Responsible IndividualRollover Instructions to Resigning CustodianMake checks payable to:Asset Description Asset Description Amount/ValueActions EditDelete There are no Entries. Add Entry Maximum number of entries reached.To rollover INVESTMENTS (private stock, real estate, LLCs, notes, etc) please complete this asset description.Digital Assets Purchase AuthorizationCompany NameRepresentativeAccount NumberDigital Asset Information Asset Name DescriptionActions EditDelete There are no Assets. Add Asset Maximum number of assets reached.Upload Image of voided checkInterested Party Email Address RelationshipNameThis field is for validation purposes and should be left unchanged.