Form Mv-37 - Application For Enrollment Or Change In Electronic Lien And Title System

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MV-37 (4-15)
APPLICATION FOR ENROLLMENT/CHANGE
IN ELECTRONIC LIEN AND TITLE SYSTEM
For Department Use Only
Bureau of Motor Vehicles • Research and Support Operations Section
PO Box 68269 • Harrisburg, PA 17106-8269
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 PennDOT.
A
ACTION REQUESTED - To Be Completed by Financial Institution
This application is for (check one):
r Initial 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)
Change of Service Provider -
r Change of Financial Institution Address -
r
(Complete Sections B and C)
(Complete Section B)
r Removal from ELT Program -
r Change of Financial Institution Name -
(Complete Section B)
(Complete Section B)
FIN# ___________________________ (Required for all selections above, except Initial Enrollment)
B
LIENHOLDER INFORMATION - To Be Completed By Financial Institution
FEIN
Name of Financial Institution/Lienholder
ABA Number
Mailing Address
City
State
Zip Code
Name of Authorized Representative (Please Print)
Date
Telephone Number
Name of ELT Service Provider - (Choose From Options Below)
(
)
VINtek
Dealertrack
PDP Group
DDI
Assurant
q
q
q
q
q
C
SERVICE PROVIDER AUTHORIZATION - To Be Completed by Service Provider
Title of Service Provider Employee
ELT Contract Authorized by: (Print Name of Service Provider Employee)
Requested ELT Start or End Date for Lienholder
Telephone Number
Email Address of Service Provider Contact Person
(
)
q
q
Start
End
Authorized ELT Service Providers:
Dealertrack Collateral
PDP Group, Inc.
Decision Dynamics, Inc.
Assurant Specialty Property
VINtek, Inc.
Management Services, Inc.
10909 McCormick Road
4723-C Sunset Blvd.
2975 Breckinridge Blvd.
1735 Market Street
9th Floor, Suite 900
9750 Goethe Road
Hunt Valley, MD 21031
Lexington, SC 29072
Duluth, GA 30096
Sacramento, CA 95827
(410) 584-2099
(803) 808-0117
(866) 742-1466
Philadelphia, PA 19103
(800) 594-1470
(215) 599-2435
-
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.
-
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 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.

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