Data Use Agreement

Fill out all the required fields below. Once you submit this agreement, we will be in touch regarding next steps.

If you are unsure of your membership or affiliate status, please check this link under the "Affiliate Membership" title.

If you are not listed on that link do not fill out this agreement. Instead, please contact Patty Reich or Denise Markow to become a member.

First, enter your email:

Email (required)

General Information

Now fill out all the required fields.

Data Licensee (Organization Name) (1)(required)

Authorized Manager

This is the full name of the official DOT/Affiliated/Consultant/University person that is authorized to take responsibility for access to the data on behalf of the DOT/Affiliate Agency/Consulting firm or University.

Full Name of Authorized Manager (2)(required)

Title of Authorized Manager (3)(required)

Street Address (required)

City (required)

State (*)

Zip (required)

Primary Contact / User

This is you, the person signing this agreement, which might be different from the person you named in field (2).

Name and Title of Primary Contact/User (required)

Phone Number (required)

Email (required)

Fax Number

Signature

By checking this box, you acknowledge that your electronic signature as authorized representative for {{ data_licensee }} will be applied to this Agreement and will have the same legal effect as a handwritten signature.

Signature (required)

{{ full_name }}, {{ licensee_title }}

Today's Date:
{{ date_first_submitted }}

Your Information:

Data Licensee (Organization Name)

Full Name

Job Title

Full Address

{{ address }}, {{city}} {{state}} {{zip}}

Name & Title of Primary Contact

Phone Number

Email Address