_______________________

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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
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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:
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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:
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Confidential communication and property of United Independent, Inc.
Last Updated 9/29/2006