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Select the type of form you would like to complete from the categories below.

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Fee Schedule
& Disclosures

Account Funding Forms

Incoming Transfer Form

Use this form to request a direct transfer of funds or in-kind assets from another custodian to Provident Trust Group.

Please note: Please remember to include a copy of a recent statement.

Deposit Slips

Complete this form when a deposit is made to your account for the following reasons: loan payments, return of funds, proceeds from a sale or maturity of an asset, income from rental properties, or interest and earnings.

This form may also be provided by a third-party when sending funds to Provident Trust Group on behalf of your retirement account.

Please note: A deposit may be delayed if this form is not submitted.

Deposit Submission Form

This form is used when funds are deposited into a Provident Trust Group account for a contribution or asset payment.

Please note: A deposit may be delayed if this form is not submitted.

ACH Deposit Form (One Time)

This form is used to request a one-time ACH deposit be made into an existing Provident Trust Group account.

Please note: Provident Trust Group, LLC initiates this transaction from your checking account.

ACH Deposit Form (Recurring)

This form is used to request a periodic recurring ACH deposit of funds into an existing Provident Trust Group account.

Please note: Provident Trust Group, LLC initiates this transaction from your checking account.

Roth IRA Conversion Form

This form is used to convert all or a portion of a traditional IRA into an existing Roth IRA at Provident Trust Group.

Please note: If you would like to establish a new Roth IRA, please click here.

Recharacterization Request

This form is used to recharacterize all or a portion of a previously completed Roth Conversion or IRA contribution to an existing traditional IRA held at Provident Trust Group.

Rollover Certification

Include this form to certify a direct rollover from an employer’s plan (401k and 403b) or to document a 60-day rollover from another IRA. You must contact your other custodian to initiate the rollover.

Please note: A deposit may be delayed if this form is not submitted with a deposit.

Asset Purchase / Investment Forms

Authorization To Take Action Form

This form is used to authorize Provident Trust Group to take further action on an existing account or existing asset (I.e., 990T, sale of asset, extend loan terms, execute documents, obtain EIN).

Direction of Investment – General

Complete this form to direct Provident Trust Group to make an investment from an existing account.

Please note: This form is not used to direct Provident Trust Group to pay an expense on an existing asset in your account.

Direction of Investment – Precious Metals

Use this form to direct Provident Trust Group to make a precious metals investment from an existing account.

Expense Payment Authorization Form

This form is required to authorize Provident Trust Group to pay an expense for an asset held in an existing account (capital calls, property taxes, insurance premiums, utility payments, management fees, etc.).

This form may also be used as a blanket authorization, to pay all bills to a specified payee, for a specific asset.

Please note: This form is not used to direct Provident Trust Group to purchase a new investment.

Solo 401(k) Loan Request Application

Use this form to initiate the processing of a loan from a Provident Trust Group Solo 401(k) account.

Distribution / Withdrawal Requests

Distribution Request – Qualified Accounts (IRA, Solo 401(k), etc.)

Use this form when taking a one-time distribution from a traditional IRA, Roth IRA, or Solo 401(k) account.

Distribution Request – Recurring

This form is used to request a periodic recurring distribution from an existing traditional IRA, Roth IRA, or Solo 401(k) account at Provident Trust Group.

Please note: You may choose to have recurring payments processed monthly or quarterly, and by check or ACH. If ACH is chosen, please attach a copy of a voided check.

Distribution Request – Cash Accounts (Non-Qualified)

Complete this form to initiate a one-time withdrawal from a non-qualified account at Provident Trust Group.

Change/Update Account Information

Adoption Agreement – Individual 401(k)

The Adoption Agreement is essentially the operating document that adopts the Qualified Retirement Plan, and allows the Plan Administrator to choose options if available in the basic plan documents.

Change/Update Personal Contact Information

Use this form if you need to update your physical or mailing address, phone number, or email address.

Change/Update Beneficiary Information

This form is used to add and remove beneficiaries from an existing account.

Credit Card Authorization Form

This form is used to authorize Provident Trust Group to initiate either a one time credit card charge for a fee, or to authorize Provident Trust Group keep your credit card on file for future fee payments.

Fair Market Valuation Form (2017)

This form is used to update Provident Trust Group as to the proper Fair Market Value (FMV) of assets held within your self-directed account. A fair market valuation should be submitted on a yearly basis to ensure proper tax reporting, the distribution of an asset in-kind, or to convert or recharacterize an asset.

Agent Authorization

Complete this form to grant or revoke informational account access to a third-party representative. This form DOES NOT give the named party the ability to direct any activity within your account.

Fee Schedule & Disclosure Forms

Fee Schedule

Please see this form for our standard fee schedule.

Please note: Fees may differ.

Financial Disclosure

This disclosure provides the financial terms and conditions associated with an account at Provident Trust Group.

Traditional IRA Disclosure

These disclosures provide the terms and conditions of your Traditional IRA account.

Roth IRA Disclosure

These disclosures provide the terms and conditions of your Roth IRA account.

SEP IRA Disclosure

These disclosures provide the terms and conditions of your SEP IRA account.

SIMPLE IRA Disclosure

These disclosures provide the terms and conditions of your SIMPLE IRA account.

Solo 401(k) Plan Disclosure

These disclosures provide the terms and conditions of your Solo 401(k) Plan.

Health Savings Account (HSA) Disclosure

These disclosures provide the terms and conditions of your Health Savings Account.

Coverdell Education Savings Account (ESA) Disclosure

These disclosures provide the terms and conditions of your Coverdell ESA.

Inherited IRA Disclosure for Traditional IRAs

These disclosures provide the Inherited IRA terms and conditions for Traditional IRA accounts.

Inherited IRA Disclosure for Roth IRAs

These disclosures provide the Inherited IRA terms and conditions for Roth IRA accounts.

Money Market Account Disclosure

This disclosure provides the terms and conditions on the liquid cash held within your account.

Privacy Policy Disclosure

This disclosure provides the terms and conditions on how we will and will not disclosure your personal information.

Do you Have Questions? Let us know!

Existing Clients
(888) 855-9856

Future Clients
(888) 662-0869

WHO WE ARE

With more than 34,000 clients in all 50 states, our elite team of professionals is the premier choice. We offer highly personalized service tailored to your needs, transforming your financial future.

CONTACT US

OUR ADDRESS

8880 W. Sunset Rd.,
Suite 250
Las Vegas, NV 89148

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FAX

(702) 253-7565

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HOURS OF OPERATION

Monday - Friday
6AM - 4PM (PST)
 

EMAIL

info@trustprovident.com

Provident Trust Group, LLC is a BBB Accredited Management Consultant in Las Vegas, NV