Transcription of ApplicAtion for EnrollmEnt/chAngE
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Example: stock market
ApplicAtion for EnrollmEnt/chAngE
( )Name of Financial Institution/LienholderMailing AddressName of Authorized Representative (Please Print)CityStateTelephone NumberDateZip CodeABA NumberName of ELT Service Provider - (Choose From Options Below) Requested ELT Start or End Date for LienholderqVINtekqDealertrackqPDP Group qDDI qSTAThis 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 PennDOT. A Action rEQUEStEd - to Be completed by financial institutionB liEnholdEr informAtion - to Be completed By financial institutionc SErVicE proVidEr AUthoriZAtion - to Be completed by Service provider Email Address of Service Provider Contact PersonTelephone NumberThis ApplicAtion is for (check one):rInitial enrollment in ELT Program (The financial institution must provide either a Federal Employer Identification number or American Bankers Association (ABA) Routing number ) - (Complete Sections B and C)rChange of Service Provider - (Complete Sections B and C)r Change of Financial Institution Address - (Complete Section B)rRemoval from ELT Program - (Complete Section B)r Change of Financial Institution Name - (Complete Section B)fin#
- The 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 the Financial Institution Number (FIN) assigned by PennDOT to all loan recipients and automotive
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