Registration Form

INDOT Electronic Permit System Registration Form

To be authorized to use the Electronic Permit System (EPS) please complete the form below and press submit when done.

* Required fields

First Name: *

Last Name: *

Company: *

Billing Contact: *

Address: *

City: *

State: *

Postal/Zip Code: *

Phone Number: *

Phone Extension:

Email Address: *

IN.gov Username: *

Are you a consulting firm?:
Yes No
Do you do Right of Way work
for a government entity?:
*
Yes No

Bonding Company Information if applicable

Company:

Address:

City:

State:

Postal/Zip Code:

Underwriting Agent:

Agent Phone Number:

Agent E-mail Address:

Bond # :

Effective Date:

Bond Amount:

Expiration Date: