2. 50 EAST 91ST
STREET | SUITE 314 | INDIANAPOLIS | INDIANA | 46240
WWW.C AN TER BU RY BEN EFITS .C OM
Dear Advisor:
Thank you for your interest in utilizing Canterbury Benefit Solutions, Inc. for providing
retirement plan design, consulting, and administration services to your valued clients. The
following page describes our services, philosophy and commitment to our clients.
Clients that we work with will experience at least one of the following:
Reduced tax liability for the business owners;
Reduced annual plan administration costs;
Improvements with the Plan administration and operational efficiency.
Additional items included for your review:
Plan Design and Implementation Process;
Individual Plan Limits by Plan Type;
Ideal Candidates;
Proposal Request Form.
We are happy to discuss your clients’ business objectives and the corresponding solutions as they
relate to an employer-sponsored retirement plan.
Please feel free to contact us at 317.816.5790 to schedule a time to meet.
Sincerely,
Steve
Steve Kyburz
Managing Partner
steve@canterburybenefits.com
7. 20160101
PROPOSAL REQUEST FORM
The data below will provide the information necessary to generate a plan proposal. Please complete all information.
Employer Name:
Employer Address:
Business Entity: □ C-Corp. (W2) □ S-Corp. (W2) □ Partnership (K-1) □ Sole Proprietor (Net-Schedule C) □ LLP
□ LLC (If LLC, indicate elected tax filing status: □ Partnership; □ Corporation; or □ Single Member)
Fiscal Year: Desired annual contribution: $ Anticipated retirement age of owner:
Does the employer currently have or ever had a retirement plan? □ Yes □ No
If yes, provide plan type and/or year terminated: ________________________________ (Includes SEP, SIMPLE, DB or any other plan type)
Do the owners have ownership interests in other businesses? □ Yes □ No
If yes, provide details:
Is the employer a member of a controlled group or affiliated service group? □ Yes □ No
If yes, provide details: _
Does the employer use leased employees, union employees or independent contractors? If yes, indicate in census. □ Yes □ No
Name
(mark U if union, L if leased, or IC if
independent contractor)
Date of
Birth
Date of
Hire
Annual
Salary
Ownership %
or Family
Relationship to
Owner
Job Title
(complete for
all requests)
Hours
worked
(if < 1,000
hours)
Representative to be contacted:
Agent/Agency Name:
Address:
Phone: Fax: Email (required):
Date proposal needed:
Email or fax the completed proposal requests to: Steve Kyburz, Canterbury Benefit Solutions, Inc.
Email: steve@CanterburyBenefits.com
Fax: 317.574.2222 | Phone: 317.816.5790
8. We look forward to sharing our
commitment to excellence.
Have a great day!