Form HSMV82150 "Application and Notice of Interest - Electronic Lien and Title Process" - Florida

What Is Form HSMV82150?

This is a legal form that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 26, 2018;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HSMV82150 by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download Form HSMV82150 "Application and Notice of Interest - Electronic Lien and Title Process" - Florida

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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.
A
ACTION REQUESTED - To Be Completed
THIS APPLICATION IS FOR: (Please check one)
Initial Enrollment in ELT Program
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
B
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.
If Yes, What Are They?
List your assigned DHSMV
Do You Have Any Other ELT DHSMV
Customer Number:
Customer Numbers?
Yes
No
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)
Federal Credit Union
Florida Bank
Federal Savings & Loan
Florida Credit Union
Out of State Bank
Florida Thrift & Loan
Out of State Credit Union
Florida Savings & Loans
Out of State Finance Company
Florida Finance Company
Out of State Savings & Loans
National Bank
Out of State Thrift & Loan
Other:
LH Mailing Address (Used for Your Titles):
State: Zip:
City:
LH Physical Address:
City:
State:
Zip:
NAME OF ELT THIRD PARTY PROVIDER: (PLEASE CHECK ONE)
Auto Data Direct, Inc., 1830 East Park Avenue, Suite 1, Tallahassee, FL 32301
www.add123.com
Office: 1-850-877-8804 Toll-Free: 1-866-923-3123 Fax: 1-850-877-5910
AutoTitles America, Inc. 6807 53rd Avenue East, Bradenton, FL 34203
info@AutoTitlesAmerica.com
Office: 1-855-526-0855 Fax: 1-941-739-8846
Dealer Support Services, Inc., 3600 Flaherty Road, Vine Grove, KY 40175
www.dmvelt.com
Office: 1-863-937-9739
Toll-Free: 1-800-848-8751
Fax: 1-863-937-9750
DDI Technology, 1 Wellness Blvd Suite 201, Irmo, SC 29063
sales@dditechnology.com
Office: 1-844-836-1621
Fax: 1-803-808-3780
FDI Collateral Management, 9750 Goethe Road, Sacramento, CA 95827
www.dealertrack.com
Office: 1-916-368-5300
Florida ELT, 700 S. Royal Poinciana Blvd. #701, Miami Springs, FL 33166
www.floridaELT.com
Office: 1-888-675-7477
Fax: 1-954-449-6028
INSTeTAG, Incorporated, 427 N. Magnolia Avenue, Orlando, FL 32801
Sales@instetag.com
Office: 1-407-254-0806 Ext. 2
Fax: 1-407-254-5988
PDP Group, Inc., 10909 McCormick Road, Hunt Valley, MD 21031
contact@simplyelt.com
Office: 1-410-584-2099
Secure Title Administration, Inc., 2975 Breckinridge Blvd., Duluth, GA 30096
securetitleinfo@secureTA.com
Toll-Free: 1-866-742-1466
Title Technologies, Inc., 14850 Montfort Drive, Suite 190, Dallas, TX 75254
ELTSupport@TitleTec.com
Office: 1-866-689-0578
Option 2 – Sales
Fax: 1-214-239-4563
VINtek Inc., 1735 Market Street, Suite 900, Philadelphia, PA 19103
cms.sales@dealertrack.com
Office: 1-877-488-0517 Option 9 - Sales
HSMV 82150 – Revised 10/09/20
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.
A
ACTION REQUESTED - To Be Completed
THIS APPLICATION IS FOR: (Please check one)
Initial Enrollment in ELT Program
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
B
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.
If Yes, What Are They?
List your assigned DHSMV
Do You Have Any Other ELT DHSMV
Customer Number:
Customer Numbers?
Yes
No
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)
Federal Credit Union
Florida Bank
Federal Savings & Loan
Florida Credit Union
Out of State Bank
Florida Thrift & Loan
Out of State Credit Union
Florida Savings & Loans
Out of State Finance Company
Florida Finance Company
Out of State Savings & Loans
National Bank
Out of State Thrift & Loan
Other:
LH Mailing Address (Used for Your Titles):
State: Zip:
City:
LH Physical Address:
City:
State:
Zip:
NAME OF ELT THIRD PARTY PROVIDER: (PLEASE CHECK ONE)
Auto Data Direct, Inc., 1830 East Park Avenue, Suite 1, Tallahassee, FL 32301
www.add123.com
Office: 1-850-877-8804 Toll-Free: 1-866-923-3123 Fax: 1-850-877-5910
AutoTitles America, Inc. 6807 53rd Avenue East, Bradenton, FL 34203
info@AutoTitlesAmerica.com
Office: 1-855-526-0855 Fax: 1-941-739-8846
Dealer Support Services, Inc., 3600 Flaherty Road, Vine Grove, KY 40175
www.dmvelt.com
Office: 1-863-937-9739
Toll-Free: 1-800-848-8751
Fax: 1-863-937-9750
DDI Technology, 1 Wellness Blvd Suite 201, Irmo, SC 29063
sales@dditechnology.com
Office: 1-844-836-1621
Fax: 1-803-808-3780
FDI Collateral Management, 9750 Goethe Road, Sacramento, CA 95827
www.dealertrack.com
Office: 1-916-368-5300
Florida ELT, 700 S. Royal Poinciana Blvd. #701, Miami Springs, FL 33166
www.floridaELT.com
Office: 1-888-675-7477
Fax: 1-954-449-6028
INSTeTAG, Incorporated, 427 N. Magnolia Avenue, Orlando, FL 32801
Sales@instetag.com
Office: 1-407-254-0806 Ext. 2
Fax: 1-407-254-5988
PDP Group, Inc., 10909 McCormick Road, Hunt Valley, MD 21031
contact@simplyelt.com
Office: 1-410-584-2099
Secure Title Administration, Inc., 2975 Breckinridge Blvd., Duluth, GA 30096
securetitleinfo@secureTA.com
Toll-Free: 1-866-742-1466
Title Technologies, Inc., 14850 Montfort Drive, Suite 190, Dallas, TX 75254
ELTSupport@TitleTec.com
Office: 1-866-689-0578
Option 2 – Sales
Fax: 1-214-239-4563
VINtek Inc., 1735 Market Street, Suite 900, Philadelphia, PA 19103
cms.sales@dealertrack.com
Office: 1-877-488-0517 Option 9 - Sales
HSMV 82150 – Revised 10/09/20
Page 1 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 Federal/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:
Fax#:
Email Address:
LH DATA PROCESSING CONTACT INFORMATION (If Applicable List Below)
Name:
Phone#/Ext:
Fax#:
Email Address:
LH AUTHORIZED REPRESENTATIVE/COMPANY CONTACT INFORMATION
(For DHSMV Field Support Center List Below)
Name:
Phone#/Ext:
Fax#:
Email Address:
LH INFORMATION PROVIDED BY (List Below)
Name:
Phone#/Ext:
Email Address:
Fax#:
DHSMV WILL USE THE FOLLOWING INFORMATION FOR WORK PROJECTIONS AND UNDERSTANDING PROJECT
DEVELOPMENT SCOPE IN ORDER TO PROVIDE EFFICIENT ASSISTANCE.
Approximate Number of Paper (Hard Copy) Titles On Hand:
Approximate Number of Titles Processed Weekly:
LH DESIGNEE NAME (Printed Name Below)
Name:
Phone#/Ext:
Fax#:
Email Address:
Title:
Company:
Date (mm/dd/yyyy):
LH DESIGNEE (Signature Below)
HSMV 82150 – Revised 10/09/20
Page 2 of 3
C THIRD PARTY PROVIDER (TPP) AUTHORIZATION – To Be Completed By Third Party Provider
Requested ELT Start or End Date for Lienholder: Start
End
(mm/dd/yyyy)
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 PROVIDER DESIGNEE (Printed Name Below)
Phone#/Ext:
Name:
Fax#:
Email Address:
Title:
Company:
Date (mm/dd/yyyy):
ELT THIRD PARTY PROVIDER DESIGNEE (Signature Below)
For Department Use Only
Name of DHSMV Reviewer:
Date (mm/dd/yyyy):
PLEASE CHECK APPLICABLE BOX(ES)
Approved
Not Approved - List Reason(s):
Further Action Needed – List Action(s):
HSMV 82150 – Revised 10/09/20
Page 3 of 3
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