
FORM 1818 (Rev. 8/11/05)
Arkansas Bureau of Standards
4608 West 61
st
Street
Little Rock, Arkansas 72209
Phone 501-570-1159 Fax 501-562-7605
APPLICATION FOR REGISTRATION
Application is hereby made under the provisions of Arkansas Code 4-18-308. Requirements for the
registration of servicepersons and service agencies for commercial weighing and measuring devices. To
perform certain weights and measures services in respect to the competence presented for consideration
by the Director.
mportant Note:
lease attach current Certificate(s) of Calibration
or all testing equipment.
Please check all that apply:
Scale Service
Meter Service
LPG Meter Service
New Applicant
Renewal
Service Agency:
Address:
(Street) (City) (State) (Zip)
Phone: Fax: E-Mail Address:
Has the applicant ever been registered as a service agency or serviceperson in Arkansas?
NO YES Reg. No._______
Does applicant have a working knowledge of the specifications and tolerances in NIST Handbook 44?
NO YES
List all testing equipment applicant has in possession or available for use:
NOTICE: Field certification of test measures may not be recognized by other states.
Under agency registration, identification of individual servicepersons is required. Each registered company will
maintain a current list of servicepersons employed by them on file with the Arkansas Bureau of Standards.
We/I understand the Arkansas Bureau of Standards may revoke the registration for just cause. By signing this
application below, applicant agrees to provide the General Code and applicable codes of the most current
edition of NIST Handbook 44 to each registered servicepersons listed on the back of this form.
(Signature of Responsible Person) (Printed Name of Responsible Person) (Date)
(Signature of Witness) (Printed Name of Witness) (Date)
NOTE: Provide appropriate evidence or references as to applicant’s qualifications by training and/or experience on reverse.
Do not complete this section
SERVICE:
Category A Scales
Retail Meters Reg. Number______ Expiration Date_______
Category B Scales
Wholesale Meters Reg. Number______ Expiration Date_______
Category C Scales
LPG Meters Reg. Number______ Expiration Date_______
Category D Scales
Scale Expiration Date______________ Reg. Number_________ Date of Calibration of Standards: _____________
Date Certificate Issued: ______________________
Recommendations of Arkansas W & M Official:
________________________________
W & M Official Signature