IRA Service Order

Please provide us with some basic contact information:
	*All items marked with a must be filled out.**
Full Name:*
Street Address:*
City:*		State:*	Zip:
Phone:*			Fax:
E-mail:

Please select the service(s) you are interested in:

1. IRA Beneficiary Election Consulting

	I am happy with my current administration company where my IRA account is held. However, I would like to have a professionally prepared beneficiary election form prepared by FSI to provide to my current administration company.

	I am not happy with my current administration company. And I would like my options for a replacement firm that is also more IRA friendly.* And/or I also would like to have FSI professionally prepare my beneficiary election form.

	I have former custom forms that were drawn up in the past but feel they may need review in light of recent IRS changes pertaining to qualified plans such as IRA's. I am sending, emailing, or faxing a copy of my current forms for review by FSI.

	Other:

	This service is available for "fixed" type insurance investments known as annuities. A referral* may be made to an on-line brokerage firm for any securities you may hold.

2. 401-k Plan Beneficiary Election Consulting

	I am happy with my current administration company where my 401-k account is held. However, I would like to have a professionally prepared beneficiary election form prepared by FSI to provide to my current administration company.

	I am not happy with my current administration company. (In-active former employer plans or frozen plans only.) I would like my options for a replacement firm that is also more 401-k/IRA friendly.* I also may desire a study to determine if my 401-k plan should remain as such or be converted to an IRA in my name. Lastly, I may also like to have a professionally prepared 401-K/IRA beneficiary election form prepared by FSI to provide to my administration company.

	I have former custom forms that were drawn up in the past but feel they may need review in light of recent IRS changes pertaining to qualified plans such as 401-K's. I am sending, emailing, or faxing a copy of my current forms for review by FSI.

	Other, please state:

	This service is available for "fixed" type insurance investments known as annuities or bank products. Also, a referral* may be made to an on-line brokerage firm for any securities you may hold.

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