_______________________ 8502 East Chapman Avenue #384 Orange California 92869 Dear Window Treatment Professional, We would like to invite you to join the United Independent team of contractors working together to provide exceptional service to our clients. Often times customers measure, order, and install product as a do it yourself project. We are recruiting experienced professionals to give our clients customers the option of having someone professionally measure and install their products for them. The products include a wide variety of both soft and hard window treatments including draperies, blinds, and shutters. United Independent prides itself on providing our contractors the highest level of volume possible by providing contractors work from companies that we service ranging from the online/catalog giant Smith & Noble, Jessitt-Gold, Window Improvements to the #1 seller of window treatments in the industry JCPenney’s. UI will be installing for 140 JCPenney test stores nation wide. So what does this mean to you? No more effort is required on your part to solicit business or collect payments. United Independent will continue to acquire key clients to add to our program and provide our contractors more volume. Additionally, working with United Independent provides such conveniences as an automated invoicing and billing process (IC’s paid weekly), automated work requests and communications and in the future, the ability to earn pay increases through our training programs and creative incentives for top performing contractors (vacations, tools, gift certificates, etc). If you are a reliable, experienced window treatment professional that would like to expand your business and work within a program the way it’s supposed to be run, this is the program for you! You will find the necessary forms required to begin the approval process. Return these forms by fax, mail or e-mail (the preferred method of communication) and include a photo copy of your driver’s license. Please see our contact information at the bottom of this letter for any further assistance. We look forward to hearing from you soon. Sincerely, Dave Spellman Senior Field Services Manager United Independent, Inc. Ph. # 866-372-7140 Fax # 866-372-7138 E-mail: [email protected] To learn more about United Independent please visit www.unitedindependent.com Version D1 Confidential communication and property of United Independent, Inc. Last Updated 10/31/2006 8502 East Chapman Avenue #384 Orange California 92869 Independent Contractor Application CORPORATE NAME (IF APP) BUSINESS OR DBA NAME PRIMARY EMAIL ADDRESS BUSINESS ADDRESS PHONE NUMBER TYPE OF BUSINESS FED. TAX ID # (OR SS # IF SOLE OR PARTNER) FAX NUMBER CELL PHONE NUMBER IS THIS BUSINESS HOME BASED? Corporation OR Partnership OR Sole Proprietorship # OF PARTNERS OR OFFICERS # OF REGULAR EMPLOYEES # OF SUB-CONTRACTORS YEAR EST List Retailers, Distributors, Chain Stores, etc that you regularly work for, or have worked for. Name # of Locations? Weekly Job Count State City Types of window coverings 1. 2. 3. List cities, counties, and states in which you are licensed to work. City, Counties / State Type of License License No. Expiration Date 1. 2. 3. Check the type of window coverings which you are proficient: Custom Draperies Wood Shutters (list manufacturer) Wood / Metal Blinds Vinyl Shutters (list manufacturer) Cellular / Pleated Shades Roman Shades Vertical Blinds Roller Shades List any other areas of expertise: SUMMARY I Certify that the above statements are true and accurate to the best of my knowledge, and that I have in good faith returned this application for the sole intent to engage business activities in conjunction with United Independent, Inc. Name Title Signature Date RETURN THIS APPLICATION AND THE SUPPORTING DOCUMENTS BY FAX TO (866) 372-7138. SHOULD YOU HAVE ANY QUESTIONS, PLEASE CALL (866) 372-7140 Version D1 Confidential communication and property of United Independent, Inc. Last Updated 7/25/2006 AUTHORIZATION FOR RELEASE OF INFORMATION FORM For use to determine authorization as an independent contractor with UI and does not constitute or create an employer/employee relationship with UI. UNITED INDEPENDENT Please Print in Black Ink or Type: Social Security #: Date of Birth: - INDEPENDENT CONTRACTOR - - - First Name (No Nicknames) Middle Initial Last Name Suffix Maiden or Other Names Formerly Used Date Last Used (Month/Year) CIRCLE A RESPONSE TO EACH OF THE FOLLOWING: *Some jurisdictions require this information to process a requested search. *RACE *SEX Male Female African American American Indian Alaskan Native Asian (Pacific Islander) Hispanic White Other-Please Specify: DRIVER’S LICENSE INFORMATION For Valid OR Non-Valid Driver’s License Complete the Following: Name as Appears on License: Date Issued: Expiration Date: Issuing State: License Number: Current Address: Street: City: State: Zip Code: County: Country: Dates Used: ADDRESS INFORMATION - FROM: - - CURRENT Previous Address (List all other cities/counties where you have lived in the last 7 years starting with the most recent): Street: City: State: Zip Code: County: Country: Dates Used: FROM: TO: Street: City: State: Zip Code: County: Country: Dates Used: Version D1 - FROM: - - TO: Confidential communication and property of United Independent, Inc. - - Last Updated 9/29/2006 Street: City: State: Zip Code: County: Country: Dates Used: - FROM: - - TO: - - PLEASE CHECK THE APPROPRIATE RESPONSE TO THE FOLLOWING QUESTIONS: Within the last seven (7) years have you been convicted of, plead guilty to, or plead “no contest” to a crime that has not been expunged from your record? (crime means felonies and misdemeanors, including vehicular misdemeanors and felonies) or been released from prison? (Examples of vehicular misdemeanors and felonies include reckless driving, driving while license has been suspended, driving without insurance, DUI’s involuntary manslaughter, damage to property, etc. Prison includes time spent in city and county jails as well as local, state, and federal prisons.) Applicants for employment in Hawaii should not answer this question at this time. Applicants in California should not answer this question as it relates to marijuana-related convictions more than 2 years old under California Health and Safety Code Sections 11357 (b) and (c), 11360 (c) 11364, 11365 NO *If yes fill in below: or 11550 YES* Date: City: State: Details: 1. Are you currently on probation or parole for a criminal offense or have you received an alternative disposition sentence for a NO criminal act? YES Date: City: State: Details: 2. Name the specific court that adjudicated the admitted hit: Court Name Date: State: NOTE: A conviction does not automatically mean you cannot enter into an agreement. Factors such as your age at the time of conviction, how long ago it occurred, the reason for the conviction and the rehabilitation you received will all be considered. I certify that the information contained herein is true and understand that any falsification will result in the rejection of my application or termination of my contractual agreement with UI. I also understand that the requested information is for the sole purpose of conducting a background investigation which may include a check of my identity, work and credit history, driving records and any criminal history which may be in the files of any state or local criminal agency. Information regarding age, sex, or race will not be used as part of any employment decision. A telephone facsimile of this authorization shall be valid as the original. I hereby authorize this company, its corporate affiliates, its employees, its authorized agents, and representatives (including American Background ) to verify all information contained in this form or in my application and to inquire into my character, general reputation, personal characteristics, and mode of living. I hereby release this company, its corporate affiliates, its employees, its authorized agents and representatives and all others involved in this background investigation from any liability in connection with any information they give or gather and any decisions made concerning my contractual relationship based on such information. I understand that the contractual offer I may receive is contingent upon the successful completion of the background investigation. I further understand that I have a right, under Section 606(b) of the Fair Credit Reporting Act, to make a written request to this company within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation requested, and for a written summary of rights pursuant to section 609(c) of the FCRA. I further agree that should I enter into a new, renewed, subsequent or modified agreement with UI, the company may need to update this information or conduct subsequent investigations from time to time during my contractual relationship and I expressly authorize such acts. (Not Applicable for CA Residents) By signing this background authorization form and pursuant to section 1786.16 of California Civil Code, you are hereby notified that we have ordered an investigative consumer report for purposes of an agreement with UI. This Investigative Consumer Report is being prepared by American Background Workplace Solutions Inc., 1000 Alderman Drive, Alpharetta, GA 30005, 877-547-2518. (CA Residents only – You may contact American Background to review your file and receive all applicable disclosures pursuant to section 1786.10 of the California Civil Code.) Please Check here to receive a copy of the Background Report (CA, OK, and MN Residents only) Please sign and date: Applicant Signature: Print Name: Date: Version D1 Confidential communication and property of United Independent, Inc. Last Updated 9/29/2006