Checkbook IRA Trust Application (SNB) -

We look forward to helping you unlock your retirement plan and start investing as you choose with a Safeguard Checkbook IRA Trust. Please provide the information below and we’ll get started promptly.

Please review our Checkbook IRA Trust Terms of Service before you begin.

If you would prefer, you may download a Checkbook IRA Trust Application to complete offline. Use this option if you wish to pay by check.

"*" indicates required fields

Contact Information

IRA Account Holder*

Please enter your full legal name

Prefix First M.I. Last Suffix

Phone*

Primary/Daytime Phone Number

Email*

Primary email address

Primary/Tax Address*

No PO boxes allowed. Will be used as official tax address of plan.

Street Address Address Line 2 City State Zip Code

County / Parish*

Please enter the county or parish associated with your primary address.

I have a different mailing address

Mailing Address

Address Address Line 2 City State Zip Code

Trust Name

Trust Name*

All names will end in "Investment Trust". Example: Acme Investment Trust. Your name does not need to be included, nor does there need to be mention that an IRA is involved. Simple and anonymous is good.

Alternate Trustee

Only appoint a co-trustee if you have another person who will be ACTIVELY involved in helping you administer investments and who needs bank signing authority. This may be a spouse, adult child, attorney, etc. This role is NOT related to plan inheritance. A successor trustee will take over administration of the trust in the event of your incapacitation or death.

Alternate Trustee (Optional)

Will another person such as your spouse be actively involved in managing plan investments?

No Alternate Trustee

Appoint a Successor Trustee

Appoint a Co-Trustee

Alternate Trustee Name

Enter the full name of the person who will be an alternate trustee

Alternate Trustee Address

Street Address Address Line 2 City State Zip Code

Co-Trustee as Bank Signer

Will your Co-Trustee be actively involved in the present-day administration of your Trust and need to have signing authority on the bank account? NOTE: They will need to complete a separate Solera Bank application for identification purposes.

Yes. The Co-Trustee needs bank signing authority.

Co-Trustee Email

Provide a unique email address for the Co-Trustee different from the one you provided for yourself.

Co-Trustee Phone

IRA Type and Funding

Please tell us more about your plan configuration and funding sources.

New IRA Type*

The new IRA type needs to match the tax type of funds being rolled over from your current plan. If you have a mix of tax-deferred and Roth funds, they cannot be combined into a single plan. Please contact your advisor for assistance.

Traditional IRA (From Traditional IRA, Rollover IRA or other tax-deferred retirement plan)

Roth IRA (From existing Roth IRA or Roth portion of an employer plan)

Inherited IRA*

Is this an IRA you have inherited?

Yes

Traditional IRA Funding Source(s)*

Check all that apply

Traditional or Rollover IRA

SEP IRA

SIMPLE IRA (must be at least 2 years old)

Employer Plan Tax-Deferred (401k, 403b, 457, TSP, pension, etc.)

New Contribution to the IRA

Roth IRA Funding Source(s)*

Check all that apply

Roth IRA

Employer Plan Roth Account (401k, 403b, 457, TSP, etc.)

New Contribution to the IRA

Initial Funding Amount*

A rough estimate of the full amount you intend to contribute, transfer, or rollover into your plan initially.

Acknowledgements

Please review the Safeguard Checkbook IRA Trust Terms of Service before completing this section.

3rd Party Designee*

I authorize Safeguard Advisors, LLC to act as a 3rd party designee on my behalf to apply for and receive an EIN from the IRS, and to answer questions about completion of form SS-4.

I have read and agree to the Safeguard Checkbook IRA Trust Terms of Service

Annual Custodial Fee Subscription*

I acknowledge and accept that a $199 per year IRA custodial fee will be billed via credit card subscription beginning in the first anniversary month of plan setup and every year thereafter. The credit card used for this invoice will be used by default. An option will be provided to specify an alternate card after plan setup has been completed.

Digital Signature*

Enter full legal name

Payment

Your Safeguard Relationship Fee can be paid personally or from the IRA. We recommend against paying from a Roth IRA account and wasting tax-free money on plan fees. If you wish to pay from the IRA, please provide a $300 deposit at this time. We will send a secondary invoice authorizing payment of the balance from the IRA once the IRA is setup. The $300 deposit may be reimbursed to you from the IRA LLC once formed. If payment from the IRA does not take place within 45 calendar days, we will charge the card provided for the balance due.

Safeguard Checkbook IRA Trust

Price:

Coupon Code

Enter a coupon code if one was provided with your plan proposal.

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Total Due Today

If your billing address is different than your primary address, please provide it here.

I have a different billing address

Billing Address

Address Address Line 2 City State / Province / Region ZIP / Postal Code

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

Contact Information

Trust Name

Alternate Trustee

IRA Type and Funding

Acknowledgements

Payment

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