Service Company Registration for Installation and Service of Weighing and Measuring Devices
Please DO NOT include any personal, confidential, and/or sensitive information in your responses on this form (e.g. social security number, credit card information, health information, account number, etc.).
Company Information
Company Name and Company Number can be found on the Service Technician registration card.
Company Name
*
company name required
Company Number
*
company number required
Company Number must be only 1-4 digits
Address 1
*
application address 1 required
Address 2
City
*
application city required
State
*
Select
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Selection Required
Zip Code
*
zip plus four
-
zip code required
zip code invalid
zip code extension invalid
Primary Phone
*
phone required
phone invalid
Phone Type
Select
C-Cell
H-Home
O-Office
Selection Required
Ext.
Alternate Phone 1
phone required
phone invalid
Phone Type
Select
C-Cell
F-Fax
H-Home
O-Office
Selection Required
Ext.
Alternate Phone 2
phone required
phone invalid
Phone Type
Select
C-Cell
F-Fax
H-Home
O-Office
Selection Required
Ext.
Alternate Phone 3
phone required
phone invalid
Phone Type
Select
C-Cell
F-Fax
H-Home
O-Office
Selection Required
Ext.
Company Contact
*
company contact required
Company Email
*
company email invalid
company email required
Contact Information
Device and Commodity Program (573) 751-5639
Petroleum Program (573) 751-5635
Metrology/Moisture Meter Program: (573) 751-3105
Fax: (573) 751-0281
Signature
I certify this information is correct
Required
you must agree to the terms
Legal Name
*
legal name required
Date 04/17/2026
Confirmation Message
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