Participating Employer Peppermint Pooled Employer Plan Setup Form

Authorized Signer on Behalf of Employer? *
Grant Web Access to the Plan? *

Additional Plan Payroll Contact (If different than business primary contact)

Authorized Signer on Behalf of Employer?
Grant Employer-Level Access to the Plan?

Business Information

We need to collect some basic information about your business.

Plan Information

We need to collect some plan information.

* The “Target Date for Asset Transfer to Peppermint Pooled Employer Plan” is an estimate based on standard industry practices. The actual Asset Transfer Date may vary, and will depend on the asset transfer dates made available by the Current/Existing Investment Recordkeeper (listed below).

** Enter the Check Date for the first payroll period for which salary deferral contributions will be made to employee accounts on the Peppermint 401k recordkeeping/investment platform.

Current Plan Provider Information

For an existing plan only. Do not complete this section if this is a brand new retirement plan.

Current/Existing Investment Recordkeeper
(i.e., the investment recordkeeper that Peppermint Pooled Employer Plan will be replacing)

Current/Existing Third Party Administrator (TPA)

Payroll Provider Information

Note: Providing this additional contact information is optional.

Special Comments and Instructions

Create Account

Use your email address to sign into the member portal after you have enrolled. 
Member Name
DOB Resident Email
Member ID Group 8116803