Company Questionnaire

Please complete the fields below, then click Submit. You can upload a completed census using the field below, or you can email the census to us separately. If you email a census to us, ensure that the Excel file is password protected. Click here for an empty census file in Excel format.

Company Information
Contact Information
Business Details
Please choose a completed Excel file from your local disk, then press the Upload button.
Files must be less than 2 MB.
Allowed file types: pdf doc xls xlsx.
Group and Plan Information
Is this business a member of a Controlled Group? *
Is this business a member of an Affiliated Service Group? *
Does this business maintain or has it ever maintained a Retirement Plan? *
Does this business sponsor a Cafeteria Plan (IRC Section 125)? *
Number of Employees
Ownership Information
List all stockholders and directors (if incorporated) or sole proprietors and partners (if not incorporated). Also list any employees who are related to these individuals and their relationship.
 NameTitleOwnership %Relationship