Application For License To Test And Repair Scales (Service-Repair Company) Form
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1
2STATE OF MISSISSIPPI
Department of Agriculture and Commerce
Lester Spell, Jr., D.V.M., Commissioner
P.O. Box 1609
Jackson, MS 39215-1609
601-359-1102
No. _________________
APPLICATION FOR LICENSE TO TEST AND REPAIR SCALES
(SERVICE-REPAIR COMPANY)
I hereby, make application for a license to install, repair and/or test scales in the State of Mississippi as provided by Section 75-27-67
Mississippi Code of 1972, as amended,
Full Name of Applicant
Give Firm Name: If corporation or partnership, give exact title
Physical Address
City
State
Zip Code
Telephone Number
Mailing Address
City
State
Zip Code
Fax Number
Nature of business
If distributor, state name and address of scale manufacture(s) represented
Is the business of the applicant owned by (a) individual, (b) partnership, (c) a corporation, or (d) a cooperative:
State business or trade names used, if any
where filed
If partnership:
NAME OF ALL PARTNERS
ADDRESS
AGES
If corporation: In what state incorporated
Date incorporation
OFFICERS
NAME
ADDRESS
President
Vice-President
Secretary
Treasurer
Chief Exec. Officer
Principal office if State of Mississippi
Is applicant a subsidiary of or affiliated in any way with any other corporation
(Continued on Back)
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