Step 1 of 6 16% IRA ApplicationPersonal InformationTitle Mr. Ms. Mrs. Dr. Legal Name Date of Birth MM slash DD slash YYYY Social Security Number Legal/Street Address Legal/City, State, Zip Mailing Address (optional) Mailing/City, State, Zip Primary PhoneFaxMobileEmail Address Marital Status Single Married (see Consent of Spouse) Widowed or Divorced Occupation Title NotificationsWould you like to review your statements online? Yes No Would you like to receive email notifications of changes to your account? Yes No Account 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 IRA Employer Name Employer Plan Document UploadMax. file size: 200 MB.Employer Name Employer Plan Document UploadMax. file size: 200 MB.Check One: Trad Roth SEP Simple Original IRA Holder Name: Check One: Self-only coverage Family coverage Account 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: BeneficiariesPlease add a designated beneficiary. If a trust, please provide first and last pages of Trust. Name Actions Edit Delete 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 Select files Accepted file types: pdf, jpg, Max. file size: 200 MB, Max. files: 3. Transfer FormCurrent IRA Custodian/TrusteeName of Custodian/Trustee Account Number Current StatementAccepted file types: pdf, png, jpg, gif, Max. file size: 200 MB.Transfer Department Address City, State, Zip Contact Name Phone NumberType of Account Traditional Roth SEP Simple HSA ESA 401(k) Beneficiary IRA Transfer 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 address Transfer 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 below Asset Description Asset Description Amount Actions Edit Delete 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 unchecked Rollover/Direct Rollover Certification FormCurrent Custodian/TrusteeName of Custodian/Trustee Account Number (if applicable) Phone NumberContact Name Type of Plan you are rolling over from: Traditional Roth SEP Simple ESA HSA Employer Plan Rollover DetailsI am an eligible person to perform this transaction: Plan Participant Spouse beneficiary of account Non-spouse beneficiary of account Responsible Individual Rollover Instructions to Resigning CustodianMake checks payable to: Asset Description Asset Description Amount/Value Actions Edit Delete 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 AuthorizationHiddenCompany Name Representative Account Number Digital Asset Information Asset Name Description Actions Edit Delete There are no Assets. Add Asset Maximum number of assets reached. Upload Image of voided checkMax. file size: 200 MB.HiddenInterested Party Email Address HiddenRelationship NameThis field is for validation purposes and should be left unchanged.