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) 000-0000
Email*
example@example.com
Business Billing Information
Billing Name*
Billing Address 1
Billing Address 2
Billing Phone
Ex. (000) 000-0000
City
State
Zip Code
Email
example@example.com
Device Types
Price Scanner
Number of Price Scanners

Up to 10 units ($50 total)11 - 25 units ($100 total)26 - more units ($150 total)
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*

Clear
Comments:
Payment Type*

CashCheck
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)
Should be Empty:

Weights and Measures Device Registration Form

Business Physical Information

Business Billing Information

Device Types

Price Scanner

Scales

Weighmaster

Mass Flowmeters

Service Agency License

Service Technician

Payment Information

ACS-14-37 (R02/25)