DS4 IRA LLC

Discount Solo 401K

Checkbook IRA LLC Application
We look forward to helping you unlock your retirement plan and start investing as you choose with a DS4 Checkbook IRA LLC. Please provide the information below and we’ll get started promptly.
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Contact Information

IRA Account Holder
Account Holder Name*
Your Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Primary/ Tax Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County and State*
Please enter the county or parish associated with your primary address.
YesNo
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
This is needed to apply for the LLC EIN

LLC Formation Details
LLC Name Choice*
Provide a unique name for the new LLC. Use exact punctuation and spelling. Names must include the LLC suffix. Examples: ABC Investment Holdings, LLC or Riverside Properties, LLC. 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 LLC Name Choice*
Please enter a 2nd name choice that is distinct from your primary choice
LLC State Formation*
The LLC state should be where the activities of the LLC will create nexus, and may not be your state of residence. Your DS4 relationship manager should have recommended the appropriate state for your situation. We do not form LLC's in California, or Massachusetts. Speak to your DS4 relationship manager if your investment interests will take place in any of these states for an alternate entity structure
A LLC must name a registered agent, which is the individual or business designated to receive delivery of official summons. This must be a resident of the state or a separate state-licensed business with a physical in-state address where notice may be delivered during normal business hours. You may act as your own agent only if the LLC is formed in your state of residency.
I will be the Registered AgentI wish to Designate my own agent (individual or Business)
Registered Agent Name*
Registered Agent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Some states collect an email address as part of the LLC filing process and use that email to send official notifications to the LLC. It may be required or optional. When optional, the email may or may not be in the public record. If no email is provided, all state communications will be via US mail.
Provide email in all casesProvide email only when privateDo not provide email if possible

Co-Manager

Only appoint a co-manager 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.
No Co-ManagerAppoint Co-Manager
Co-Manager Name*
Full Legal Name of Co-Manager
Co-Manager Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co-Manager as Bank Signer

Will your co-manager be actively involved in the present-day administration of your LLC and need to have signing authority on the bank account? NOTE: They will need to complete a separate Solera Bank application for identification purposes.
YesNo
Co-Manager Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Co-Manager Email*
example@example.com

Acknowledgements
Signature*

Clear
Date*

MonthDayYear
Date

My Products*

DS4 Checkbook IRA LLC

$749.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

- Fenn
- (Rev. December 2019)
Department of the Treasury Internal Revenue Service

Application for Employer Identification Number (For use by employers, corporations, partnerships, trusts, estates, churches, government agencies, Indian tribal entities, certain individuals, and others Go to www.irs.gov/FormSS4 for instructions and the latest information.
EIN
See separate instructions for each line. ► Keep a copy for your records.
Legal name of entity (or individual) for whom the EIN is being requested
(LLC Name)
Trade name of business (if different from name on line 1)

Executor, administrator, trustee, "care of" name
(Your Name)
Address

Mailing address room, apt., suite no. and street, or P.O. box 5a Street address if different Don't enter a P.O. box

Street Address Line 2

·;:: City, state, and ZIP code (if foreign, see instructions) 4bState / Province

Postal / Zip Code
·;:: City, state, and ZIP code (if foreign, see instructions) 4b
City, state, and ZIP code (if foreign, see instructions) 5b
Cl 6
County and state where principal business is located
(Your Name)
(Your SSN)
If is "Yes," enter the number of Is this application for a limited liability company (LLC) Sb Ba 0 (or a foreign equivalent)? If Ba is "Yes," was the LLC organized in the United States? . 9a Type of entity (check only one boxCaution: If Ba is "Yes," see the instructions for the correct box to check. D Sole proprietor (SSN) Estate (SSN of decedent) D D Partnership D Plan administrator (TIN) D Corporation (enter form number to be filed) Trust (TIN of grantor) D D Personal service corporation D Church or church-controlled organization Farmers' cooperative Federal government D D D Other nonprofit organization (specify) Indian tribal governments/enterprises D 0 Grou Exemption Number (GEN) if any Other (specify) ► IRA If a corporation, name the state or foreign country (if State Foreign country applicable) where incorporated Reason for applying (check only one box) Banking purpose (specify purpose) ► OPEN BANK ACCOUNT D Started new business (specify type) Changed type of organization (specify new type) D D Purchased going business D Hired employees (Check the box and see line 13D Created a trust (specify type) D Compliance with IRS withholding regulations D Created a pension plan (specify type) D Other (specify) Closing month of accounting year Date business started or acquired (month, day, yearSee instructions.

D Military/National Guard D State/local government
D REMIC
DECEMBER
(Today's Date)

MonthDayYear
Date
If you expect your employment tax liability to be $1,000 or

less in a full calendar year and want to file Form 944 annually instead of Forms 941 quarterly, check here. (Your employment tax liability generally will be $1,000 or less if you expect to pay $5,000 or less in total wages If you don't check this box, you must file Form 941 for every quarter. D Note: If applicant is a withholding agent, enter date income will first be paid to . Check one box that best describes the principal activity of your business. Health care & social assistance D Wholesale-agent/broker D D Construction Rental & leasing Transportation & warehousing Accommodation & food service Wholesale-other Retail D D D D D D Real estate D Manufacturing D Finance & insurance Other (specify) ► IRA INVESTMENT HOLDINGS Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.

Highest number of employees expected in the next 12 months (enter -0-if noneIf no employees expected, skip line 14.

First date wages or annuities were paid (month, day, year nonresident alien (month, day, year) .

No Has the applicant entity shown on line 1 ever applied for and received an EIN? D 0 Yes If "Y " es, write previous EIN h ere Complete this section only if you want to authorize the named individual to receive the entity's EIN and answer questions about the completion of this form. Designee's telephone number Qnclude area code) Designee's name
IRA INVESTMENT HOLDINGS
Third Party Designee
Travis Rhodes
303-209-8600
Designee's fax number (include area code)
319 S SHERIDAN BLVD, LAKEWOOD, CO 80226
435-586-1125
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.

Applicant's telephone number (include area code)

Name and title (type or print clearly)
(Your name/Manager)
Phone Number)
Format: (000) 000-0000.
Applicant's fax number (include area code)

(Print name again) For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Should be Empty:

Discount Solo 401K

Contact Information

LLC Formation Details

Co-Manager

IRA Type and Funding

Acknowledgements

EIN

(LLC Name)

Cl 6

D REMIC

DECEMBER

IRA INVESTMENT HOLDINGS

Third Party Designee

Travis Rhodes

303-209-8600

319 S SHERIDAN BLVD, LAKEWOOD, CO 80226

435-586-1125