Island Ink-Jet - Confidential Questionnaire

Confidential Questionnaire

Great organizations are a result of great people. This is especially the case in the franchising business. And so, before we award an Island Ink-Jet franchise, we need to review some of your background information. By completing our Confidential Questionnaire you will help us confirm that you are, indeed a great fit for our organization. After all, birds of a feather flock together.

Once we have reviewed your Confidential Questionnaire, we will contact you to confirm any other information we may need. By completing our Confidential Questionnaire you are NOT committing to purchasing an Island Ink-Jet franchise.

For residents in the State of Illinois, Island Ink Jet Systems (US) Inc. is not currently registered. We are unable to market to interested parties in this state. Please do not complete the Confidential Questionnaire. Please check this website for updates on Registration approval.

Personal Data

Family Name:	*
First Name:	*
Address:	*
City:	*
County name
State/Province:	*
Country:	*
Postal/Zip Code:	*
# years at this address:
Telephone, Home	*
Business Phone:
Email Address:	*
How did you hear about us?	*

Education

Highest level of education completed:	*
Name of School, College or University:
Diploma Received:

Work History

Current/Last Occupation:
Name of company:
Company Address:
City, State:
Type of Business:
Your title/duties:
With current employer since:
Were you promoted within this company?	Yes No
Reason for leaving (if applicable):

Island Ink-Jet And You

I am interested in:*

Single Unit Multi Units

Where are you interested in opening an Island Ink-Jet franchise?

Area Interested 1: *

In case this area is no longer available, what are your second and third choices?

Area Interested 2:
Area Interested 3:

Island Ink-Jet is primarily located within regional shopping centers, do you have any shopping centers currently in mind?

If so, list three:

How long have you been seeking a business?:

Would you work full time at your Island Ink-Jet Customer Service Center?*

Yes No

Will you have a partner?*

Yes No
Indicate their relationship to you:

Will he/she be active in the business?*

Yes No
If yes, please explain:

What features interest you most about Island Ink-Jet?*
What personal qualities and qualifications do you possess that you feel would enable you to operate a successful franchise?*

What do you feel would be the key ingredients for the success of an Island Ink-Jet franchise?*

Are you presently associated with, or have an interest in, any other business? If yes, please explain:*

Have you, or a company with which you were associated, ever declared bankruptcy? If yes, please explain:*

Professional References (please indicate name, telephone number and relationship)

1.
2.

Personal References (please indicate name, telephone number and relationship)

1.
2.

Financial Information

I MAKE THE FOLLOWING STATEMENT OF ALL MY ASSETS AND LIABILITIES AS OF THE* DAY OF* the year 20*

Banking Relations

(A list of all my bank accounts, including Savings and Loans)
Name and Location of Bank, Cash or Loan balance. +$ 10,000 or -($ 10,000)*

Assets

1. Cash	$ *
2. Accounts/Loans Receivable	$ *
3. Investments	$ *
4. Real Estate (value)	$ *
5. Automobiles (registered in your name)	$ *

Liabilities

1. Notes Payable to Banks, Direct Borrowings only	$ *
2. Accounts Payable and Credit Cards	$ *
3. Mortgages Payable on Real Estate	$ *
4. Other Liabilities (itemized)	$
	$
	$

Source Of Income

1. Salary:	$ *
2. Bonus Commissions	$
3. Dividends and Interest	$
4. Real Estate Income	$
5. Other Income (itemized)	$
	$
	$

Island Ink-Jet Systems Inc. and Island Ink-Jet Systems (US) Inc. (collectively referred to as "Island Ink-Jet")

The UFOC (Uniform Franchise Offering Circular) is a federally mandated document intended to provide complete disclosure on our franchise offering to US residents. If you are a resident of the USA or interested in opportunities in the USA, you must have this document in your possession for at least 14 calendar days or 10 business days before purchasing an Island Ink-Jet franchise. If everything is in order on this questionnaire we will mail you a UFOC and confirmation receipt immediately after our investigation is complete.

I hereby consent to Island Ink-Jet obtaining any credit or investigation reports in connection with this questionnaire. I hereby further consent to Island Ink-Jet taking whatever actions it considers necessary to verify the information set forth above, including contacting any of the references listed above.

I understand that Island Ink-Jet Systems Inc. may provide this information to agents representing Island Ink-Jet Systems Inc. on a need to know basis in qualifying a sale.

I understand that Island Ink-Jet will keep all information concerning this questionnaire confidential, and that it is for the express use of Island Ink-Jet and its Area Developers only. None of this information will be shared in anyway with anyone outside of Island Ink-Jet at any time. By completing this questionnaire you are consenting to the collection of the above information for the purpose of qualifying only those requirements of awarding a franchise. This questionnaire is not a binding offer or contract from Island Ink-Jet Systems Inc. to grant a franchise.

I agree *

None of the communications made through this web page should be construed as an offer to sell an Island Ink-Jet Systems Inc. franchise. Further, the communications made through this web page should not be construed as an offer to sell an Island Ink-Jet franchise in, nor is any such communication directed to the residents of, any jurisdiction requiring registration of the franchise before it is offered and sold in that jurisdiction. No Island Ink-Jet Systems Inc. franchise will be offered or sold to any prospective franchisee, including any resident of any such jurisdiction, until the offering has been (as applicable) exempted from the requirements of or duly registered in and declared effective by such jurisdiction, and the required Uniform Franchise Offering Circular (if any) has been delivered to the prospective franchisee before the offer or sale in compliance with applicable law. If you have any questions concerning the registration status of Island Ink-Jet franchises in your jurisdiction, please contact the Legal Department at the Island Ink-Jet International Franchise Support Centre in Courtenay, British Columbia, Canada (1-877-4INKJET)

Copyright 2006 Island Ink-Jet Systems Inc.
Island Ink-Jet Systems Inc. and Island Ink-Jet Systems (US) Inc. (collectively referred to as "Island Ink-Jet")