Serviceman Registration Application 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.).
Applicant Information
Last Name
*
*
First Name
*
*
Middle Initial
Suffix
Select
III
IV
Jr.
Sr.
*
Primary Phone
*
*
x
Phone Type
Select
C-Cell
H-Home
O-Office
*
Ext.
Technician E-mail Address
*
*
x
Confirm E-mail Address
x
email and confirm email do not match
Registration areas selection
Validate Registration Area
check at least one type of registration area
Scales
Fuel Devices
Other Devices
Grain moisture meters
Electric Vehicle Charging Devices
Taxi Meters
Other
Other Description
*
State Statutes
https://revisor.mo.gov/main/OneChapter.aspx?chapter=413
https://revisor.mo.gov/main/OneChapter.aspx?chapter=414
https://revisor.mo.gov/main/OneChapter.aspx?chapter=323
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 ceritfy this information is correct
you must agree to the terms
Legal Name
*
legal name required
Date 09/07/2024
Confirmation Message
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