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Preliminary Plan Worksheet

Use this form to gather the information required to set up your self-directed 401(k).

Once submitted, a representative from Brickhouse Consulting will contact you to help you through the process.

Your Contact Information

Name*

Phone*

Email*

Plan Information

Plan Name (e.g., “Company Name” 401k Plan)

Trustee(s) (Primarily majority business owner(s))

Designated Main Contact Person (HR Director)

Main Contact Email Address

Trustee Information

Trustee 1 Name

Phone

Home Address

Social Security Number

Driver's License Number

Date of Birth

Expiration Date

Trustee 2 Name

Phone

Home Address

Social Security Number

Driver's License Number

Date of Birth

Expiration Date

Trustee 3 Name

Phone

Home Address

Social Security Number

Driver's License Number

Date of Birth

Expiration Date

Trustee 4 Name

Phone

Home Address

Social Security Number

Date of Birth

Driver's License Number

Expiration Date

Plan Year-End

Calendar (12/31)

Fiscal (please specify)

Eligibility Requirements

1 Year of Service

Other (please specify)

Age 21

Other (please specify)

Semi-Annual Entry

Quarterly Entry

Other (please specify)

Immediate Entry for Those Currently Employed

Contributions

Profit Sharing

Matching

Pretax Salary Deferrals

Roth Salary Deferrals

Safe Harbor Match (100% of 4%)

Safe Harbor Nonelective (3%)

Vesting

Full and Immediate

3-Year Cliff

6-Year Graded

In-Service Distributions

Age 59½

Hardships

Loans

Additional Notes

Thank you. Your content has been submitted.

An error occurred. Please ensure all required fields (outlined in red) have been filled.

Past performance is not indicative of future results. Investing involves risks, including the possible loss of principal.

Brickhouse Consulting is a fee-only, directed consulting firm and does not provide tax, legal or investment advice. any information communicated by Brickhouse Consulting is for educational purposes only, and should not be construed as tax, legal or financial decision. Please consult with your tax, attorney or financial professional.

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Preliminary Plan Worksheet

Your Contact Information

Company Information

Plan Information

Trustee Information