MDB401k First Plan Order Form for companies with no previously established 401k plan or other company retirement plan
1) Will this be your company's first 401k plan or are you replacing an already-existing plan?	First 401k plan Already-existing 401k plan to be converted to a MDB401k plan (STOP!!! Please use our Plan Conversion Order Form instead of this New Plan Order Form. Thank You.)
Part I:Company Information...
2) Company name:
3) Contact person:
4) Title:
5) Phone:	-
6) Fax:	-
7) E-mail:
8) Your 401k decision-making role:	Sole decision maker Making recommendation Leading committee to gather information Member of committee to evaluate options Interested employee Other:
9) Company address:
10) City:
11) State:
12) Zip:
9-12alt)9-12alt) Company mail-to address:	Use address listed above as mail-to address Use other address:
13) Federal ID number:
14) Date business commenced:
15) Type of entity:	Please indicate your company's type: S Corporation Professional Service Corporation Corporation Sole Proprietorship Partnership other: Is your company a member of a controlled group? Yes No Unsure. Please contact me regarding this question. Is your company a member of an affiliated service group? YesNoUnsure. Please contact me regarding this question.
16) # of employees on payroll:
17) Fiscal year on which business is run:	January 1 - December 31 Other: Unsure. Please contact me regarding this item.
18) Computer system:	MDB401k runs on Windows 95 and above. Is your computer running Windows 95 or above? Yes No Unsure. Please contact me regarding this item.

Part II:

Plan Information...

Note:

Complete the below ONLY if the MDB401k plan will be your company's FIRST retirement plan ever.

If your company already has a retirement plan and will be having MDB401k replace that plan, please use our Plan Conversion Order Form instead of this New Plan Order Form. Thank You.

19) Potential size,
in number of employees,
of your MDB401k plan:

Number of full-time employees currently on your payroll:

1-4

5-15

16-25

26-50

51-75

76-100

101-125

126-150

151-175

176-200

more than 200

Unsure. Please contact me regarding this item.

20) Plan Administrator:

Who at your company will serve as Plan Administrator for your MDB401k plan? If you don't know who will serve as your Plan Administrator, mark the "Unsure. Please contact..." box below.

will serve as Plan Administrator for our MDB401k plan. His/her phone number is , and e-mail address is . Optional: His/her title ("Controller," "CFO," "President" etc.) is .

Unsure. Please contact us about naming our plan's Administrator.

21) Plan Trustee(s):

Who at your company will serve as your MDB401k plan's Trustee(s)? Please include his/her/their title(s) (such as "CFO"), as applicable. If you are unsure who will serve as your plan's trustee(s), mark the "Unsure. Please contact..." box below.

Trustee(s) phone number(s): .

Unsure. Please contact us about naming a Plan Trustee(s).

22) Compliance test preferences:
(remember, just mark "Unsure" if you want help with any item)

You have some flexibility regarding the parameters by which the IRS compliance tests your plan will have to pass each year are run. Your MDB401k software will have your preferences hardwired into it so you can run accurate compliance tests as often as you like (we recommend monthly) from your MDB401k software to keep you apprised of your plan's health and help ensure your plan passes its critical year-end tests.

On what basis would you like your plan to define Highly-Compensated versus Non-Highly-Compensated Employees?

Not applicable: Safe harbor plan

Previous year's wages

Current year's wages

Unsure. Please contact me regarding this item.

The determination of Highly-Compensated versus Non-Highly-Compensated Employees for your plan will be based on the previous year's wages. Would you like your plan to limit the definition of Highly-Compensated Employees to "the top 20% of employees"?

Not applicable: Safe harbor plan

Yes (recommended)

Unsure. Please contact me regarding this item.

23) Age requirement for participation
in MDB401k plan:

What participant age requirement do you want for your MDB401k plan?

None

20 1/2

Other (please specify):

Unsure. Please contact me regarding this item.

24) Length of Service requirement for your
MDB401k plan?

What participant length of service requirement do you want for your MDB401k plan?

None

Three (3) months of service with the company

Six (6) months of service with the company

One (1) year of service with the company

Other (please specify):

Unsure. Please contact me regarding our MDB401k plan length of service requirement.

25) Participation exclusions:

Would you like to exclude any categories of employees from participation in your MDB401k plan?

Yes

Unsure. Please contact me regarding participation exclusions used in our existing company plan.

If "Yes", please identify the classes of employees you'd like to exclude from participation in your MDB401k plan: (check all that apply)

Union members (recommended)

Non-resident aliens (recommended)

26) Automatic enrollment:

Do you want your MDB401k plan to use automatic enrollment?

Yes No Unsure. Please contact me regarding this item.

If "Yes", what would you like the default contribution rate to be for automatically enrolled participants?

Not applicable. Do not want auto enrollment used in our MDB401k plan.

3% 4% 5%

Unsure. Please contact me regarding using auto enrollment in our MDB401k plan.

27) Employer contributions:

NOTE: If you plan to run your 401k as a safe harbor plan, please indicate any relevant safe harbor employer contributions at item 30 of this order form and DO NOT include your safe harbor contribution formula(s) herein under item 27 Employer Contributions.

Your company can contribute to plan participants' accounts in any of three ways:
(1) regular matching contributions,
(2) discretionary employer contributions, and/or
(3) qualified nonelective contributions.

Regular matching contributions (RMCs) are defined in terms of participant's elective contribution (e.g., 50� contributed by the employer for each dollar contributed by the plan participant). Discretionary employer contributions (DECs) are basically profit-sharing contributions, although the employer's contribution does not have to be limited to net profits. Qualified nonelective contributions (QNECs) are allocated on the basis of compensation or some other variable aside from a participant's elective contribution; they are made to ALL eligible employees regardless of whether or not the employee contributes to or participates in the 401k plan -- unless the QNEC is being used to satisfy ADP or ACP test corrections. As for vesting, RMCs and DECs can be subject to vesting schedules, but QNECs are always 100% vested to employees' accounts when made.

1) Would your company like to have the option of making any REGULAR MATCHING CONTRIBUTIONS to employees' accounts?

No regular matching contributions will be made.

Our company MAY make regular matching contributions at a rate our company will define later.

Our company will make regular matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan.

Our company will make regular matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan, up to a maximum annual matching contribution of $ per participant per year.

Other:

Unsure. Please contact me regarding regular matching contributions.

2) Would your company like to have the option of making DISCRETIONARY EMPLOYER CONTRIBUTIONS (i.e., profit-sharing contributions) to employees' accounts?

No, we do not want the option of even possibly making profit-sharing contributions.

Yes, our company MAY make profit-sharing contributions in an amount to be determined by our company. We DO NOT want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)

Yes, our company MAY make profit-sharing contributions in an amount to be determined by our company. We DO want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)

Unsure. Please contact me regarding profit-sharing contributions.

3) Would your company like to have the option of making QUALIFIED NONELECTIVE CONTRIBUTIONS to employees' accounts?

No (except as needed for discrimination test corrections).

Yes, our company MAY make qualified nonelective contributions in an amount to be determined by our company. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)

Yes, our company will make qualified nonelective contributions equal to % of the total compensation of all participants eligible to share in the allocations.

Unsure. Please contact me regarding qualified nonelective contributions.

28) Vesting of
employer contributions:

"Vesting" herein refers to ownership of employer contributions. It is a way to reward continued employment with your company. For instance, if you pick Schedule D below for any profit-sharing contributions made and a plan participant leaves your company after 2 years, he or she will only be entitled to 20% of any profit sharing contributions made to his or her account. The remainder will go into a pool that your company can choose to use for employer contributions owed to other participants.

Please indicate the vesting formula you want for any matching and/or profit-sharing contributions (qualified nonelective contributions, by law, are 100% vested when made). Mark your choice for profit-sharing contributions in column P-S Contribs and for matching contributions in column Match Contribs.

P-S Contribs	Match Contribs	Vesting Schedule
		Not applicable (no employer contributions of this type, so no vesting)
		SCHEDULE A:	100% immediate vesting
		SCHEDULE B:	0-2 years 3 years	= =	0% vested 100% vested
		SCHEDULE C:	0-4 years 5 years	= =	0% vested 100% vested
		SCHEDULE D:	0-1 years 2 years 3 years 4 years 5 years 6 years	= = = = = =	0% vested 20% vested 40% vested 60% vested 80% vested 100% vested
		SCHEDULE E:	1 year 2 years 3 years 4 years	= = = =	25% vested 50% vested 75% vested 100% vested
		SCHEDULE F:	1 year 2 years 3 years 4 years 5 years	= = = = =	20% vested 40% vested 60% vested 80% vested 100% vested
		Other:
Unsure. Please contact me regarding the vesting schedule(s) to use for our 401k plan. On what basis would you like vesting to be calculated for your plan? Not applicable (no employer contributions) Effective date of plan Date employee hired (recommended) Unsure. Please contact me regarding our plan's vesting basis.

29) Loans:

Do you want your MDB401k plan to allow for 401k loans (that is, for participants to borrow from their accounts)?

Yes

Unsure. Please contact me regarding 401k loans.

30) Safe harbor designations:

The IRS allows 401k plan sponsors an alternative to subjecting their 401k plans to annual discrimination testing. The safe harbor method of plan operation lets employers instead make certain contributions to the plan, with immediate vesting of the contributions to employees' 401k accounts.

Do you want to operate your MDB401k plan as a safe harbor 401k plan?

Yes

No (you can skip the rest of this section 30)

Unsure. Please contact me regarding operating our 401k plan as a safe harbor plan.

If you are choosing to operate your 401k plan as a safe harbor plan, which employer contribution formula would you like to employ?

Not applicable (don't want to use the safe harbor method)

Make a qualified nonelective contribution equal to 3% of compensation to each eligible employee's account. (Note: Qualified nonelective contributions are made to ALL eligible employees accounts, regardless of whether the persons participate in the company 401k plan.)

Make dollar-for-dollar matching contributions to non-highly-compensated employees on salary deferrals up to 3% of compensation and 50� to the dollar matching contributions to non-highly compensated employees on salary deferrals of 3% to 5% of compensation, making sure not to exceed these rates in any matching contributions made to highly compensated employees. (Note: Matching contributions, because they're based upon salary deferral amounts, are made only to currently-participating employees' 401k accounts.)

Define our contribution rate and type at a later date, in no event later than 30 days before the end of our Plan Year.

Unsure. Please contact me regarding the type of 401k safe harbor contribution to make.

If you are choosing to operate your 401k plan as a safe harbor plan, how often do you want your employer contributions to be made?

Not applicable (don't want to use the safe harbor method)

Annually

Per payroll period

Per month

Per quarter

Unsure. Please contact me regarding the frequency of making our 401k safe harbor employer contributions.

Part III:MDB401k Shopping Cart...

31) MDB401k Annual Fee (based on plan size):

Plan Size Annual Fee

1-4 eligible employees $495 a year

5-15 eligible employees $695 a year

16-25 eligible employees $995 a year

26-50 eligible employees $1295 a year

51-75 eligible employees $1495 a year

76-100 eligible employees $1995 a year

101-125 eligible employees $2295 a year

126-150 eligible employees $2495 a year

151-175 eligible employees $2795 a year

176-200 eligible employees $2995 a year

more than 200 eligible employees (contact us for quote)

32) One-time, first-year-only nonrefundable plan setup and software customization fee ($500 for all plans):

33) TOTAL (system + setup fee):

Additional item:

Part IV:Payment Preference...

NO PAYMENT IS DUE AT THIS TIME.
We will contact you within 24 hours of receiving your order to confirm your designations, answer any questions you have, and give you quotes on any Additional Items you've requested.

36) Do you prefer to be contacted regarding your order by telephone or e-mail?

Contact by phone

Contact by e-mail

After you submit your MDB401k order, a representative will call you within 24 hours (on business days) to go over any items you marked as "Unsure" and to answer any additional questions you have.

When our representative calls you, you will be able to pay your $500 MDB401k setup fee using your Visa, Mastercard, or American Express Card, or you can send a check through the mail; there is a five-day holding period on all check orders.

As soon as we receive your setup fee, we will prepare your official 401k Adoption Agreement and Summary Plan Description for your review, then customize your 401k software upon your OK of the documents and payment of your MDB401k annual fee.

Depending on how quickly they get back to us in reviewing their 401k Adoption Agreement, most clients have their customized MDB401k systems within two weeks.

37) How will you prefer to pay for your MDB401k system when we contact you?

credit card via phone

credit card via e-mail

check

Part V:How did you hear about us?

38) One last thing before you submit your order: Please tell us how your heard about MDB401k:

Financial planning professional, friend or colleague. Please list the person and/or company name:

Linked to the MDB401k website from another website. Please tell us the name of the site and/or company sponsoring it:

Web search. Please list the browser and search term(s), if you remember them (e.g., Netscape, 401k software):

Business or trade publication. Please give the name of the publication:

Other. Please explain:

39) Now please look over our 401k Software User's Agreement, then submit your order or inquiry. Please note, as the User's Agreement stipulates, that the 401k software and related services are provided by 401(k) Pro, Inc.; Mydiscountbroker is solely the investment provider. Please also note that submitting an order acknowledges that you have read and accept the User's Agreement but in no way obligates you to making any purchase.

Home | Contact Us | To Order