
( )
Name of Financial Institution/Lienholder
Mailing Address
Name of Authorized Representative (Please Print)
City State
Telephone Number
Date
Zip Code
ABA Number
Name of ELT Service Provider - (Choose From Option Below)
Requested ELT Start or End Date for Lienholder
❑ VINTEK ❑ FDI ❑ PDP Group ❑ DDI
This form is to be used by financial institutions and other lienholders to enroll in Pennsylvania’s Electronic Lien and Title (ELT)
Program, and to modify an ELT account with the Department.
A ACTION REQUESTED - To Be Completed by Financial Institution
B LIENHOLDER INFORMATION - To Be Completed By Financial Institution
C SERVICE PROVIDER AUTHORIZATION - To Be Completed by Service Provider
E-mail Address of Service Provider Contact Person
Telephone Number
This application is for (check one):
❒ Initial Enrollment in ELT Program (Financial Institution must provide either a Federal Employer Identification Number or
American Bankers Association routing number) - (Complete Sections B and C)
❒ Change of Service Provider - (Complete Sections B and C) ❒ Change of Financial Institution Address - (Complete Section B)
❒ Removal from ELT Program - (Complete Section B) ❒ Change of Financial Institution Name - (Complete Section B)
FIN# ___________________________ (Required for all selections above, except Initial Enrollment)
( )
ELT Contract Authorized by: (Print Name of Service Provider Employee)
Title of Service Provider Employee
❑ Start
❑ End
Authorized ELT Service Providers:
FEIN
Research and Support
Operations Section
P.O. Box 68269
Harrisburg, PA 17106-8269
MV-37 (4-09)
For Department Use Only
Application for
Enrollment/Change
in Electronic Lien
and Title System
VINtek, Inc.
1735 Market Street
9th Floor, Suite 900
Philadelphia, PA 19103
(215) 563-3320
FDI Collateral Management
9750 Goethe Road
Sacramento, CA 95827
(800) 594-1470
PDP Group, Inc.
10909 McCormick Road
Hunt Valley, MD 21031
(410) 584-2099
www.simplyelt.com
Decision Dynamics, Inc.
4723-C Sunset Blvd.
Lexington, SC 29072
(803) 808-0117
- Financial Institutions must complete Sections A and B, then forward this form to the selected service provider.
- This completed application must be submitted to PennDOT by the authorized ELT service provider named in Section B.
- Lienholder must contract with one of PennDOT’s approved ELT service providers for transmission of all vehicle and title data.
Participating lienholders agree to the following conditions and requirements:
- The lienholder must provide Financial Institution Number (FIN) assigned by PennDOT, to all loan recipients and automotive
dealers utilizing selected lienholder services.
- The lienholder must work directly with the contracted service provider’s Help Desk to resolve all ELT discrepancies and data
transmission issues.
- The lienholder must protect the confidentiality of the information and data to which lienholder has access. At no time will the
lienholder furnish to any person, association or organization any vehicle or title data received from PennDOT without
PennDOT’s prior written consent.
- The lienholder has no proprietary rights to the information received from PennDOT.
- The lienholder understands that PennDOT and its employees shall not be liable to the lienholder for any damage, costs, lost
production or any other loss of any kind for failure of PennDOT’s equipment, hardware or software or for the loss of
consequential damages that are the result of any other type of failure.
- Authorization may be terminated by either party upon giving 30 days written notice to the other party. In the event of
termination, PennDOT is released from any and all obligations to the lienholder.