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PROPOSAL REQUEST FORM
Date:
To obtain a custom retirement plan fee proposal, please complete and return this form to DailyAccess Corporation. INVESTMENT ADVISOR INFORMATION
Please enter all information as it should appear on the proposal. Name: Phone: Commission-based Fax: Fee-based Company Name: E-mail:
PLAN INFORMATION
Plan Name: Current Provider: Type of Plan: Total Number of Employees: Total Number of Participants: Rank of Importance (1 = most important, 5 = least important) Fiduciary Responsibility Recordkeeping Only Current Trustee: Total Assets:
$
Total Number of Eligible Employees:
Plan Design Proposal is for:
Technology Full Service
Costs
Communication
THIRD PARTY ADMINISTRATOR
DailyAccess Contact Name: Phone: Address 1: City: Proposed Fund List Ticker 1 2 3 4 5 6 7 8 9
Please Note: Additional fund options are available; charges may apply.
Other TPA (please provide information below)
Note: TPA will not be allowed to administer plan without prior DailyAccess approval.
Firm: E-mail: Website: Address 2: State: ZIP:
Name
Assets 10 11 12 13 14 15 16 17 18
Ticker
Name
Assets
Form DAC 3-082 Rev. 7/2009
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PROPOSAL REQUEST FORM
Date proposals are needed:
Standard turnaround time is 3-5 business days.
Type of Proposal:
E-mail Hardcopy
E-mail Address: If hardcopy, how many proposals are needed? Proposal should be sent to the following address: Name: Address: City: State: ZIP:
How did you hear about us?
To e-mail the completed form to DailyAccess, please click the Submit button below. When your e-mail browser opens, click Send. If you are prompted to save the file, save it and then attach it in an e-mail to info@dailyaccess.com.
Submit
To fax the completed form, print and send it to 251-665-1810. For assistance from the DailyAccess Sales Team, please call 888-535-4322 or e-mail info@dailyaccess.com.
For Internal Use Only
If proposal is for Recordkeeping only: Model 1 Model 2 Model 3
Form DAC 3-082 Rev. 7/2009
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