Application and Notice of Interest Electronic Lien and Title Process

If a financial institution that operates in the State of Florida wishes to enroll in the state’s electronic lien and title program, the following application form has to be used. Complete the form and submit it along with any required information.

Extracted Text for Proper Search

HSMV 82150 – 
Revised 04/03/17 Page 	1 of 3	 	
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES	 	
APPLICATION AND NOTICE OF INTEREST - ELECTRONIC LIEN AND TITLE PROCESS	 	2900 APALACHEE PARKWAY, MS68 RM. A332 - TALLAHASSEE, FL 32399- 0610	  Pursuant to Chapters 319, 320, and 328, Florida Statutes, this form is to be used by financial institutions and other Lienholders 
to  enroll  in  Florida’s  Electronic  Lien  and  Title  (ELT)  Program  to  secure  liens  electronically  within  Florida  and  to  modify  an  ELT 
account with the Department. 
Change of 
Third Party Provider	
  Change of 
Financial Institution  Address and/or  FEIN Notice of Inactive Participant ELT 
Program  Change of 
Financial Institution  Name  LIENHOLDER (LH) 
INFORMATION – 	
To Be Completed By  Lienholder/Financial Institution The Department assigns 	
the 	Lienholder 
a DHSMV 	Customer Number upon initial  enrollment and requires it on all 
requested ELT actions. If  the Lienholder  already has  an assigned  DHSMV Customer  Number, it is  to  be listed  and used.	 
The  Lienholder/Financial  Institution must provide  a Federal  Employer  Identification  Number	 
(FEIN)  and any DHSMV-assigned  suffix. 
List your assigned DHSMV	
 
Customer Number:  Do 
You  Have  Any Other  ELT DHSMV	 
Customer  Numbers? 
 
No	
  If 
Yes,  What  Are They?  Federal Employer Identification Number (FEIN): 
DHSMV-assigned suffix:
Name of Lienholder - Financial Institution/Doing Business As (DBA): 
Note:  Please 
include a copy of  your Federal/State  Charter/License  with this Application.  TYPE OF 
BUSINESS/FINANCIAL INSTITUTION:  (PLEASE CHECK ONE) Florida Bank	
  Federal 
Credit Union  Florida Credit 
Union  Federal 
Savings  & Loan  Florida Thrift 
& Loan  Out of State 
Bank	
 Florida Savings 
& Loans  Out of State 
Credit Union	
  Florida Finance Company  Out 
of State Finance Company  National 
Bank  Out of State 
Savings & Loans  Other:	
  Out of State 
Thrift & Loan LH 
Mailing  Address  (Used for Your  Titles):	
  City:	  State: 
Zip:	 LH 
Physical  Address:  City:	
 
State:   
 Zip:	  NAME 
OF ELT  THIRD  PARTY  PROVIDER:  (PLEASE CHECK ONE)  Secure Title Administration, Inc., 2975 Breckinridge Blvd., Duluth, GA 30096
 
Toll-Free: 1-866-742-1466 [email protected]
 Auto 
Data Direct, Inc.,  1379 Cross Creek Circle, Tallahassee, FL 32301  
Office: 1-850-877-8804   Toll-Free:  1-866-923-3123   Fax: 1-850-877-5910 www.ADD123.com
  www.AutoTitlesAmerica.com
 Dealer Support Services,	
 Inc., 
1511  E. Lake Parker Drive, Suite 2, Lakeland, FL 33801  
Office: 1-863-937-9739  Toll-Free: 1-800-848-8751  Fax: 1-863-937-9750  www.dmvelt.com
 Decision Dynamics, Inc., P. O. Box 2078, Lexington, SC 29072	
 
Office: 1-803-808-0117  Fax: 1-803-808-3780	  [email protected]
 FDI Collateral Management,	
 9750 Goethe Road, Sacramento, CA 95827	 
Office: 1-916-368-5300  www.dealertrack.com 
Florida ELT, 700 S. Royal Poinciana Blvd. #701, Miami Springs, FL 33166 
Office: 1-888-675-7477  Fax: 1-954-449-6028	
 
www.floridaELT.com
 I	
NSTeTAG, Incorporated, 427 N. Magnolia Avenue, Orlando, FL 32801 
Office: 1-407-254-0806 Ext. 2  Fax: 1-407-254-5988  [email protected] 
PDP Group, Inc., 10909 McCormick Road, Hunt Valley, MD 21031 
Office: 1-410-584-2099	
 
contact@
si	mplyelt.com  Title Technologies, Inc., 14850 Montfort Drive, Suite 190, Dallas, TX 75254 
Office: 1-866-689-0578  Option 2 – Sales  Fax: 1-214-239-4563	
 
[email protected] 
VINtek Inc.,	
 1735 Market Street, Suite 900, Philadelphia, PA 19103 
Office: 1-877-488-0517   Option 9 - Sales	  cms.sales@dealert
rack.com AutoTitles America, Inc. 6807 53rd Avenue East, Bradenton, FL 34203
 
Office: 1-855-526-0855  	
 Fax: 1-941-739-8846
A	
  Initial Enrollment in ELT ProgramACTION REQUESTED - To Be Completed
THIS APPLICATION IS FOR: (Please check one)
B
 
Yes

HSMV 82150 – 
Revised 04/03/17 Page 	2 of 3	 	
Participating Lienholders agree to the following conditions and requirements:	 	
•	Lienholder/financial institutions  must  contract  with one  of DHSMV’s  approved ELT  Third  Party  Providers  for
transmission  of  all  vehicle  and title  data.	
•	Lienholder/financial  institutions  must complete  Sections  A and  B,  then  complete  this  form  electronically  and send  a
signed original  copy to the selected  Third Party Provider with a copy of the Lienholder’s F ederal/State
Charter/License, if applicable.	
•	This  completed  application  must be  submitted  electronically  to DHSMV  by the  authorized  ELT  Third  Party Provider
named  in Section  B.  The  Third  Party  Provider  must retain  the  original  signed  completed  application and  all other
documentation  on  file  for audit  purposes.	
•	Lienholder  must  provide  the  DHSMV  Customer  Number assigned  by  DHSMV  to  all  loan  recipients,  motor  vehicle,
mobile  home, and vessel  dealers  applying  for  title  on  the  form  HSMV  82040 “Application  for  Certificate  of Title
With/Without  Registration” utilizing selected  Lienholder  services.	
•	Lienholder  must work directly  with  the  contracted  Third Party Provider’s  Help Desk  to  resolve  all  ELT  discrepancies
and  data  transmission  issues.	
•	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 motor  vehicle,  mobile  home, vessel,  or  title  data 
received  from  DHSMV  without DHSMV’s  prior  written  consent.	
•	Lienholder  has  no  proprietary  rights to the  information  received from DHSMV.	
•	Lienholder  understands  that DHSMV  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 DHSMV’s  equipment,  hardware, or  software  or  for  the  loss
of  consequential  damages that  are  the  result  of  any  other  type of  failure.	
•	Lienholder  must comply  with  all applicable  Florida  Statutes  and DHSMV  policy and  procedures  as an  ELT  program
participant.	
Note	: Applicant must have entered into a contract with Third Party Provider before applying to become an ELT 
Lienholder participant. If applicant is changing Third Party Provider: (1) all pending transactions with the 
previous Third Party Provider must be complete; (2) a contract must be signed with the new Third Party 
Provider and; (3) the Department must be notified prior to using the new provider’s services.	
 	
LH ADMINISTRATIVE CONTACT INFORMATION (List Below)	 	
Name:  	Phone#/Ext:	 	
Email Address:	 	Fax#:	 	
LH DATA PROCESSING CONTACT INFORMATION (If Applicable List Below)	 	
1DPH	3KRQH([W		
(PDLO$GGUHVV 	)D[		
LH AUTHORIZED REPRESENTATIVE/COMPANY CONTACT INFORMATION 	(For DHSMV Field Support Center List Below)	 	
1DPH	3KRQH([W		
(PDLO$GGUHVV 	)D[		
LH INFORMATION PROVIDED BY (List Below)	 	
1DPH	3KRQH([W		
(PDLO$GGUHVV 	)D[		
DHSMV WILL USE THE FOLLOWING INFORMATION FOR WORK PROJECTIONS AND UNDERSTANDING PROJECT 
DEVELOPMENT SCOPE IN ORDER TO PROVIDE EFFICIENT ASSISTANCE.	 	
$SSUR[LPDWH1XPEHURI3DSHU+DUG&RS\\f7LWOHV2Q+DQG		
$SSUR[LPDWH1XPEHURI7LWOHV3URFHVVHG:HHNO\ 
LH DESIGNEE NAME (Printed Name Below)	 	
1DPH		3KRQH([W		
(PDLO$GGUHVV	)D[		
7LWOH		&RPSDQ\		
LH DESIGNEE (Signature Below)	 	'DWHPPGG\\\\\f	

HSMV 82150 – 
Revised 04/03/17  Page 	3 of 3	 C 
THIRD PARTY PROVIDER (TPP) AUTHORIZATION –  To Be Completed By Third Party  Provider Requested ELT	
 
Start  or End  Date  for Lienholder:  Start 
(mm/dd/yyyy)  End 
I certify that the entity above meets the requirements to become 
an authorized electronic Lienholder (ELT). The entity will abide 
by all laws, rules, procedures, and contractual obligations required. I will ensure that all lien transactions are done in 
accordance with laws  and Department procedure. I further certify that state and county fees collected will  be remitted 
electronically in accordance with state law. I understand that failure to comply with any laws, rules, or contractual terms shall  be 
grounds for the Department to revoke my authorization to use the ELT system. 
The applicant agrees to comply with section 119.0712 (2), Florida Statutes,  and the Federal Driver’s Privacy Protection Act 
(18 U. S. C.  § 2721 et seq.). The applicant agrees that all personal information governed by these statutes will  be used or 
redisclosed by the applicant only as permitted by these statutes. Any use or redisclosure of such personal information by the 
applicant except as permitted by these statutes will result in DHSMV revoking applicant’s ability to use the system. 
Under penalty of perjury, I  do swear and affirm that the information contained in this application is true and correct  and that 
applicant will abide by all laws of Florida and all applicable rules, policies , and procedures of the Department of Highway Safety 
and Motor Vehicles.  ELT THIRD PARTY P
ROVIDER DESIGNEE ( Printed Name Below) Name:  Phone#/Ext: 	
Email Address:
 	Fax#:  Title:  Company: 	
ELT THIRD PARTY PROVIDER DESIGNEE (Signature Below)	 	Date (mm/dd/yyyy):	 	
For Department Use Only	 
Name of 
DHSMV Reviewer:   Date (mm/dd/yyyy): 

PLEASE CHECK 
APPLICABLE BOX(ES)
 	
Approved	 
Not A
pprove d - L	
ist Reason(s):
 	
Further Action Needed – List Action(s):