Checkbook Control IRA, QRP, & 401k Application

Step 1 of 2

Service & Pricing Overview
We look forward to working with you through every step of the process, leveraging ReSure's expertise, resources and relationships. At the core of our offering to you are our educational resources, delivered through a combination of one-on-one expert sessions and web-based materials. The service includes establishment of a single-plan of your selection, which you'll choose through a guided process after getting started.
Your Personal Information
First Name*
Last Name*
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Phone*
Physical Address
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Payment Authorization Form
Payment Authorization*
- By checking this box you authorize ReSure LLC to collect the fees due for ReSure Investor Account formation and related services, including applicable recurring payments. You may cancel this agreement at any time prior to initiation of services and receive a refund of your payment, less a $300 application fee. Once services are initiated under this agreement, all initial fees are non-refundable. For this purpose, service will be deemed to commence with the initiation of communication, through any medium, between yourself and ReSure representative(s) subsequent to submission of this application form. Either party may cancel service at any time, for any reason. Subsequent billings to your card will be halted after cancellation.
ReSure Investor Account Services*
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Nature of Our Services to You
Terms & Acknowledgement*
- By signing below, you represent and warrant that you have provided, and will provide, ReSure LLC, its management, its representatives, and related persons ("ReSure") complete and accurate information and that ReSure may rely upon such information or any direction you may give to ReSure. You acknowledge and agree that ReSure shall have no duty to monitor your actions regard to your retirement account(s). You acknowledge and agree to the following: ReSure is not acting as investment advisor, plan administrator, trustee, or fiduciary to your retirement account(s). Any information provided by ReSure is not intended to be a substitute for advice from your accountant, attorney, or tax advisor. It is agreed that ReSure’s responsibility for damages, or claims of damage, arising from any form of action other than gross negligence, shall not exceed the total amount paid for the services invoiced. This shall be the exclusive remedy for such causes of action. Either party may bring no action, regardless of form, arising out of the services provided under this agreement, more than one year after the date of the last service provided under this agreement. Any dispute related to services provided shall be settled by arbitration in Kings County, New York according to the rules of the American Arbitration Association. Arbitration is final and binding on the parties. The parties are waiving their rights to seek remedies in court, including the right to a jury trial. The laws and jurisdiction of the State of New York shall govern any and all matters related to this agreement. By signing this document, you consent to transact business using electronic communications, to receive notices and disclosures electronically, and to utilize electronic signatures in lieu of using paper documents.
Digital Signature (First and Last Name)*
Your typed name above constitutes a signature.
Date*
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Notes