PDD Authorization Application

IED Portal

An Official Pennsylvania Government Website

Step 1 of 8

PDD Authorization Application

Required fields are marked with an asterisk.(*)

Applicant Information

Applicant's First Name

Applicant's Last Name

Address

City

State

Zip Code

Mailing address (if different)

Mailing address

Mailing Address City

Mailing Address State

Mailing Zip Code

Principal Point of Contact

First Name

Last Name

Title

Telephone Number (+1-XXX-XXX-XXXX)

Email Address

Emergency Contact (if different from Principal Point of Contact)

First Name

Last Name

Title

Telephone Number (+1-XXX-XXX-XXXX)

Email Address