Sample Questionnaire

Wholesale Lockbox Imaging Sample Questionnaire

IMAGE SERVICES General Information

Company Name: ABC Company Contact: John Smith

Image Capture Requirements

Cheque Only – Images of all cheques (available for all sites) Image All Documents – cheques / invoices / correspondence Image All Documents – cheques / invoices / correspondence including envelopes

Image Services

Image CD-ROM (Delivered with regular back up- if different provide details under additional instructions)

Frequency Daily Weekly Monthly 2 # of Copies

Clients with multiple lockboxes Include all lockboxes on one CD Create a separate CD for each lockbox

Web Access Web Reports (includes Deposit Advice, Cheque List, and if applicable, Activity Report

Billing Instructions (Please denote which lockbox CD charges should be applied to)

Primary Lockbox: T10000C Secondary Lockbox(es): T10001C

Detailed Additional Instructions Please send one copy of the CD with the regular back up and the other CD to: 123 Anywhere St. M5B 1P1 Toronto, ON Canada

CONFIDENTIAL