Vendor Information Questionnaire

Freddie Mac strives to seek out vendors offering the highest quality products and services at the lowest costs. To be considered, please supply us with the information requested below.

Required fields are indicated by an asterisk *.

Contact Information




*	Company Name
*	Contact Name

	Address
*	Line 1		Mailstop
	Line 2
	Line 3

*	City
*	State/Province	(required for U.S. or Canada)
*	Zip/Postal Code
*	Country

*	Telephone
	Fax
	Email Address

	State of Incorporation (if other than above)

	Company Name where Incorporated (if other than above)

Product/Service Information

*	Please select the category that best describes your product or service:

*	Subcategory: (if any)

*	Specific Product or Service to be Provided:

Sales/Service Area: Local Regional Nationwide International

Business Profile

*	Type of Business	*	1099 Reportable?	Yes No
*	Explain, if Other		Year Started (YYYY)
*	Number of Employees		Prior Fiscal Year Annual Gross Sales

	Stock Symbol (if applic.)		Exchange
	Dun & Bradstreet Number	*	Tax ID (SSN) or	- -
	Website URL	*	Tax ID (EIN)	-

Business Licenses/Permits/Registrations

State of Registration	Registration/Filing #
	Number	City/County, State of Issuance
License (Type):
Permit (Type):

Minority/Woman-Owned Status

If this company is a concern in which at least 51% of the combined total of all classes of stock is owned by any of the following groups, who are US citizens, and who also control¹ and operate²the business, please check all boxes below that apply:
African Americans Asian-Indian Americans Asian-Pacific Americans
Hispanic Americans Native Americans Woman-Owned Business
¹exercising power to make policy decisions
²being actively involved in the day-to-day management

This company has been certified as a minority/woman owned business enterprise by: US Govt Agency State Agency Local Agency Minority Council/Org Other

If Other, please explain:

Please e-mail a copy of certification to Supplier Diversity. If unable to send electronically, mail to:

Freddie Mac
Supplier Diversity MS #113
8250 Jones Branch Drive
McLean VA 22102-3110

References

Please provide below three current or past clients that are representative of the work for which you wish to be considered.

Reference #1

*Company

*Contact Name

*Address

*City

*State/Province (required for U.S. or Canada)

*Zip/Postal Code

*Country

*Telephone

E-mail Address

* Please provide a brief description of the products offered and/or professional consulting services provided:

Number of Professional Personnel Assigned (if applicable):

Skill Sets (if applicable):

Reference #2

Company

Contact Name

Address

City

State/Province (required for U.S. or Canada)

Zip/Postal Code

Country

Telephone

E-mail Address

Please provide a brief description of the products offered and/or professional consulting services provided:

Number of Professional Personnel Assigned (if applicable):

Skill Sets (if applicable):

Reference #3

Company

Contact Name

Address

City

State/Province (required for U.S. or Canada)

Zip/Postal Code

Country

Telephone

E-mail Address

Please provide a brief description of the products offered and/or professional consulting services provided:

Number of Professional Personnel Assigned (if applicable):

Skill Sets (if applicable):

Insurance

Provide coverage amounts. If not applicable, please enter a zero, '0', for the amount.

*	Comprehensive/General Liability	*	Umbrella Liability
*	Professional Liability	*	Auto Liability
*	Fidelity Bond	*	Other

General

Please check the applicable boxes. Use the space below to provide explanations for any 'yes' answers.

Yes No	*	1) Has Freddie Mac ever previously done business with your Company?

Yes No	*	2) Does any member¹ of your Company have a personal relationship with a current Freddie Mac employee?

Yes No	*	3) Have you or any key employees² ever been employed by Freddie Mac?

Yes No	*	4) In the past two years has your company provided any services to the Office of Federal Housing Enterprise Oversight, Department of Housing and Urban Development or Federal National Mortgage (Fannie Mae)?

Yes No	*	5) Are you currently or previously been a defendant in a lawsuit brought by a client or supplier?

Yes No	*	6) Have you ever filed for protection from creditors under a Federal or State bankruptcy statute?
¹ owners, partners, officers, anyone holding 10% or more of company stock if publicly traded and key employees. ² an employee likely to perform a managerial role in delivering your potential product or who has played a role in establishing contact between companies

Quality Commitment

List below any trade, business or consumer organizations your company is a member of:

List below any accolades/awards received by your company or senior officers

Referral

*How did you learn of this questionnaire? If you are providing an unsolicited offer for our review, please skip and continue to the next section.

Signature

Signature below represents that all supplied information is complete and accurate.
As the authorized representative of the contractor identified below, I agree that by typing my name in the "Signature" box below and by typing my title in the "Title" box below and transmitting or submitting this information to Freddie Mac, I have signed and intended to sign this Vendor Information Questionnaire on behalf of said contractor using an electronic signature. On behalf of said contractor, I further agree that said contractor will be bound by the statements in and terms of this electronic record in the same manner that said contractor would have been bound if I had signed a paper Vendor Information Questionnaire using an ink pen and delivered the form to Freddie Mac.

*	Signature of Authorized Representative:
*	Title:
	Date:	11/21/2009

Submission of this form is for informational purposes only. It does not guarantee any contracts will be awarded or ensure "Approved" Vendor status. You will be contacted at Freddie Mac's discretion. Submissions providing products/services not currently sought will be maintained for future consideration.

Please print a copy for your records before submitting this form.