You are about to request access to a secure site. Information that you enter in this page will be investigated for authenticity and accuracy. If you are not an employee of an ORI number-defined agency, please do not complete this request form.

Automated License Plate Reader FTP Access Registration

NOTE: The fields indicated with an asterisk (*) below are required to complete this form
*Access Type: Agency ID User Specific ID
*Agency ORI:
*First Name:
*Middle Name:
*Last Name:
*Last Four SSN:
*Date Of Birth: / /
Title:
Address:
*City:
*State:
Zip Code:
*Phone:  ext.
*E-Mail:
*Re-Enter E-Mail:
Fax:
*Enter Password:
*Re-enter Password:
  Note: Passwords must be at least 8 characters in length, cannot contain spaces, and must contain at least one upper case character, lower case character, number, and at least one of the following special characters !@#$%^&*()+=

The first character must be an upper case character, lower case character or number.