Rollover Support Ticket

After submission of this form, an Empower Representative will contact you within 24-72 hours using the phone number provided. If you are not available at the time of their call, they will leave you a voicemail and follow up with you by sending an email to the email address we have on file.

Legal Name (as used in the Empower system):(Required)

First Last

Last Four Digits of Social Security Number:(Required)

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Last Four Digits of Social Security Number:(Required)

Email(Required)

Enter Email Confirm Email

Best phone number to contact you:(Required)

Best time of day to reach you:(Required)

Time Zone:(Required)

How many accounts would you like to rollover?(Required)

What financial institutions are these accounts currently with?(Required)

To list multiple financial institutions, add additional rows by clicking the + button to the right of the row.

Phone

This field is for validation purposes and should be left unchanged.