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Device and Scanner Registration Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Business Name
*
Date
*
Date
Corporate Name (If Applicable)
Business Address
*
City
*
State & Zip Code
*
Billing Address
Check If Same As Business Address
Billing Address
City
State & Zip Code
Contact Name
*
Contact Title
Contact Email
*
Contact Phone Number
*
Extension
How Many Different Device Types Are Being Registered?
*
1
2
3
4
Devices
*
-- Select One --
Computing scale
Computing scale with POS system
Scanners/Point of Sale System
Counter scale
Hanging scale
Portable Platform scale
Jeweler/Prescription/Cannabis scale
Hopper scale
Railway scale
Dormant scale
Livestock/Animal scale
Vehicle scale
Taxi meter
Vapor submeter
Water submeter
Vehicle meter
Electric meter
Fabric/Cordage/Wire meter
LPG meter
Retail Motor Fuel Device
EVSE
Other (please specify below)*
Device Capacity (if applicable)
Quantity of Device(s)
Devices
-- Select One --
Computing scale
Computing scale with POS system
Scanners/Point of Sale System
Counter scale
Hanging scale
Portable Platform scale
Jeweler/Prescription/Cannabis scale
Hopper scale
Railway scale
Dormant scale
Livestock/Animal scale
Vehicle scale
Taxi meter
Vapor submeter
Water submeter
Vehicle meter
Electric meter
Fabric/Cordage/Wire meter
LPG meter
Retail Motor Fuel Device
EVSE
Other (please specify below)*
Device Capacity (if applicable)
Quantity of Device(s)
Devices
-- Select One --
Computing scale
Computing scale with POS system
Scanners/Point of Sale System
Counter scale
Hanging scale
Portable Platform scale
Jeweler/Prescription/Cannabis scale
Hopper scale
Railway scale
Dormant scale
Livestock/Animal scale
Vehicle scale
Taxi meter
Vapor submeter
Water submeter
Vehicle meter
Electric meter
Fabric/Cordage/Wire meter
LPG meter
Retail Motor Fuel Device
EVSE
Other (please specify below)*
Device Capacity (if applicable)
Quantity of Device(s)
Devices
-- Select One --
Computing scale
Computing scale with POS system
Scanners/Point of Sale System
Counter scale
Hanging scale
Portable Platform scale
Jeweler/Prescription/Cannabis scale
Hopper scale
Railway scale
Dormant scale
Livestock/Animal scale
Vehicle scale
Taxi meter
Vapor submeter
Water submeter
Vehicle meter
Electric meter
Fabric/Cordage/Wire meter
LPG meter
Retail Motor Fuel Device
EVSE
Other (please specify below)*
Device Capacity (if applicable)
Quantity of Device(s)
*Retail Motor Fuel Devices are counted by each grade of gasoline and/or diesel on each dispenser.
* Notes
Please include any other information, concerns, or questions here.
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