Online Billing User Registration Form

Attention Requestor: Please provide us with your contact information so that we may confirm receipt of your request. Name: eSignature Form E-mail:* Online Billing Phone: User Registration Form

Complete this User Registration Form to request, modify or remove a user’s access to Online Billing and/or Desktop Reporting services.

Online Billing Service - Assign only one billing role.  Billing User - able to view and download invoices online.  Billing Point of Contact - able to view and download invoices online, edit the corporate profile data and payment information.

* Required Current Subscription Information **Required if New

Company/Licensee Name: * Subscriber ID(s): (i.e. a1234b) *

Do you have a Fannie Mae User ID? * No Yes, enter user ID (8-character i.e. a1234xyz):

Add New User Add Application to Existing User Delete Application from Existing User Delete Existing User User’s Name: * Title: Address: (if different than Company/Licensee): City/State/Zip Code: Phone: ** E-mail: ** PIN (4-digits): **

Important: New users must provide a unique PIN. The PIN will be required during the password retrieval process and must contain exactly four numerals and should not be easy for others to guess. Password retrieval instructions will be sent to the e-mail address designated on this form for each user. (Please retain a copy of this form.)

Please check the appropriate box to indicate the role that this user requires: Online Billing Service Select one billing role:

Billing User Add Delete

Billing POC Add Delete

Authorized and Requested By: Company /Licensee Name: * I understand and agree that, by entering my name in the space below, I am representing that: (a) I am a duly authorized officer or signatory authority of the company identified above, (b) the individual identified above qualifies as an “Authorized User” under the terms and conditions of the most recent version of the Fannie Mae Software Subscription Agreement between Fannie Mae and the company, (c) the company represents and warrants that the information in this form is complete and accurate and Fannie Mae is entitled to rely on it and (c) the company intends to be bound by my electronic signature just as if it were an ink signature on paper. Name of Authorized Title: * Date: * Officer/Signatory Authority: *

Please return completed forms via e-mail to: [email protected] Last Updated on 1/5/2015