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PennDOT Identity Services Portal

Register Enterprise Organization: Organization Information

1		Organization Information
Organization Information

2		Data Release Agreement
Data Release Agreement

• = Required

Organization Details

•Organization Name	•Federal Employer Identification Number(FEIN)

Please use the complete name of the organization/company.
Organization Description

Remaining Characters: 500

Legal Address

•Country

•Street Address 1	Street Address 2

•City	•State/Province

•Zip Code/Postal Code

Contact Person Information

•First Name	•Last Name

•Email Address	•Primary Phone

Brief Explanation

•Brief explanation
	Please provide a brief explanation describing why you need to register the organization. Please note that the brief explanation you provide will be considered by the approver when reviewing your request.
Remaining Characters: 500