Weights and Measures Device Registration Form ACS 14-37 ADA Comp

Weights and Measures Device Registration Form
Application Year
Ex. 2025
WINWAM #
Business Physical Information
Business Name
Business Address 1
Business Address 2
City
Zip Code
Parish
Phone
Ex. (000) 000-0000Format: (000) 000-0000.
Email
example@example.com
Business Billing Information
Billing Name
Billing Address 1
Billing Address 2
Billing Phone
Ex. (000) 000-0000Format: (000) 000-0000.
City
State
Zip Code
Email
example@example.com
Device Types
Price Scanner
Number of Price Scanners
Type a question
Amount due for Price Scanner Total
Scales
Number of Category 1 Scales (1,000 lbs capacity or less)
Amount due for Category 1 Scales
Number of Category 2 Scales (1,001 to 10,000 lbs)
Amount due for Category 2 Scales
Number of Category 3 Scales (over 10,000 lbs)
Amount due for Category 3 Scales
Weighmaster
Number of Weighmaster
Amount due for Weighmaster
Mass Flowmeters
Number of Mass Flowmeters
Amount due for Mass Flowmeters
Service Agency License
Number of Service Agency License
Amount due for Service Agency License
Service Technician
Number of Service Technician
Amount due for Service Technician
Grand Total Due
Payment Information
Preparers Name
Preparers Signature
Comments:
Payment Type
Check Number
Once you complete and submit the form, please print and mail your form with payment to:

Louisiana Department of Agriculture & Forestry
5825 Florida Blvd Suite 5000
Baton Rouge, LA 70806

Need Help? Call 225-925-3780 or weightsinfo@ldaf.state.la.us
ACS-14-37 (R02/25)
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