"Order Form for Placed-In-Service / Inspection Report Forms & Certification Stamps" - New Hampshire

Order Form for Placed-In-Service / Inspection Report Forms & Certification Stamps is a legal document that was released by the New Hampshire Department of Agriculture, Markets & Food - a government authority operating within New Hampshire.

Form Details:

  • The latest edition currently provided by the New Hampshire Department of Agriculture, Markets & Food;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Agriculture, Markets & Food.

ADVERTISEMENT
ADVERTISEMENT

Download "Order Form for Placed-In-Service / Inspection Report Forms & Certification Stamps" - New Hampshire

Download PDF

Fill PDF online

Rate (4.8 / 5) 5 votes
NH DIVISION OF WEIGHTS AND MEASURES
ORDER FORM FOR PLACED-IN-SERVICE / INSPECTION REPORT FORMS &
CERTIFICATION STAMPS
Mail order form to:
Service Technician Name: _______________________
Division of Weights & Measures
Service Tech. Signature: ________________________
P.O. Box 2042
Service Company:_____________________________
Concord, NH 3302-2042
Address: _____________________________________
(603) 271-3700
City: ________________________________________
Fax: (603) 271-1109
State:________________________________________
A check or money order must accompany

Zip Code:____________________________________
the order, and be made payable to:
Telephone:___________________________________
Treasurer, State of NH”
UPS Acct. No.: _______________________________
FED EX Acct. No.: ___________________________
PLACED-IN-SERVICE/INSPECTION REPORT FORMS
COST
QTY
TOTAL
25 forms per pad

Retail Motor Fuel Devices
$6.00 ea.
(Gas Pumps) (code: A1)
Vehicle Tank Meters
$6.00 ea.
(Not Temperature Corrected) (code: A2)
Refined Petroleum Products
$6.00 ea.
(Temperature Correction – VTM) (code: A3)
Large Volume Petroleum Measuring Devices (Code: A4)
$6.00 ea.
Liquid Petroleum Gas Meters (Code: A5)
$6.00 ea.
Other types of Liquid Measuring Devices (code A6)
$6.00 ea.
Taxi Meters (code: A7)
$6.00 ea.
Vehicle Scales (code: B1)
$6.00 ea.
Scales/Linear Measures (code: B2)
$6.00 ea.
CERTIFICATION STAMPS
$25.00 ea.
packs of 50 @ $25.00 each

ORDER TOTAL:
$
(Includes Placed-in-Service Reports & Certification Stamps)
For Office Use:
Date Received:____/____/____
Date Shipped (if applicable):____/____/____
Check Amount: $____________
Check/Money Order No.:________________
Certification Stamps purchased: Start #:______________ End #: ______________
NH DIVISION OF WEIGHTS AND MEASURES
ORDER FORM FOR PLACED-IN-SERVICE / INSPECTION REPORT FORMS &
CERTIFICATION STAMPS
Mail order form to:
Service Technician Name: _______________________
Division of Weights & Measures
Service Tech. Signature: ________________________
P.O. Box 2042
Service Company:_____________________________
Concord, NH 3302-2042
Address: _____________________________________
(603) 271-3700
City: ________________________________________
Fax: (603) 271-1109
State:________________________________________
A check or money order must accompany

Zip Code:____________________________________
the order, and be made payable to:
Telephone:___________________________________
Treasurer, State of NH”
UPS Acct. No.: _______________________________
FED EX Acct. No.: ___________________________
PLACED-IN-SERVICE/INSPECTION REPORT FORMS
COST
QTY
TOTAL
25 forms per pad

Retail Motor Fuel Devices
$6.00 ea.
(Gas Pumps) (code: A1)
Vehicle Tank Meters
$6.00 ea.
(Not Temperature Corrected) (code: A2)
Refined Petroleum Products
$6.00 ea.
(Temperature Correction – VTM) (code: A3)
Large Volume Petroleum Measuring Devices (Code: A4)
$6.00 ea.
Liquid Petroleum Gas Meters (Code: A5)
$6.00 ea.
Other types of Liquid Measuring Devices (code A6)
$6.00 ea.
Taxi Meters (code: A7)
$6.00 ea.
Vehicle Scales (code: B1)
$6.00 ea.
Scales/Linear Measures (code: B2)
$6.00 ea.
CERTIFICATION STAMPS
$25.00 ea.
packs of 50 @ $25.00 each

ORDER TOTAL:
$
(Includes Placed-in-Service Reports & Certification Stamps)
For Office Use:
Date Received:____/____/____
Date Shipped (if applicable):____/____/____
Check Amount: $____________
Check/Money Order No.:________________
Certification Stamps purchased: Start #:______________ End #: ______________