← 3ff566ec-c623-42e0-9ceb-2b0c0a1f3ee4_New_Technician_Form__1_.pdf
Rebuilt HTML — PaddleOCR-VL (Baidu)
Content placed at each item's bbox to mirror the original PDF layout (font sizes are estimated). overlay · view JSON
Page 1
Download HTML
Maryland
Department of Agriculture
Office of Marketing, Animal Industries and Consumer Services
Wes Moore, Governor
Aruna Miller, Lt. Governor
Kevin M. Atticks, Secretary
Steven A. Connelly, Deputy Secretary
The Wayne A. Cawley, Jr. Building
50 Harry S Truman Parkway
Annapolis, Maryland 21401
Agriculture | Maryland's Leading Industry mda.maryland.gov
The Wayne A. Cawley, Jr. Building
50 Harry S Truman Parkway
Annapolis, Maryland 21401
410-841-5862 Baltimore/Washington
410-841-5780 Fax
Application for Service Agency/Service Technician
Service Agency Information
| Company Name | Company Id Number | ||
| Company Email | Company Phone # |
□Electric Vehicle Charging
Scales ☐Meters
| Tech Information | ||
| Name | Phone | |
Please include with the application a copy of ALL current certification of traceable standards from a NIST approved state lab.
Fees:
- Service agency registration/renewal biennial fee: $250 every two years
Fee for each new service technician or service technician license renewal: $75.00
State of Maryland Class/exam fee: $25 - NCWM exams accepted
For NCWM exams use the following link https://www.ncwm.com/rsa-program. The exam is 50 for members and 100 for Non-members. You have the option of selecting an in-person proctor exam (State of Maryland 25) or a virtual proctor exam (20).
Enter Company Name
Enter Company Id Number
Enter Company Email
Enter Company Phone #
Select for Scales
Select for Meters
Select for Electric Vehicle Charging
Enter Name of Technician 1
Enter Email of Technician 1
Enter Phone Number of Technician 1
Enter Name of Technician 2
Enter Email of Technician 2
Enter Phone Number of Technician 2
Enter Name of Technician 3
Enter Email of Technician 3
Enter Phone Number of Technician 3
Enter Name of Technician 4
Enter Email of Technician 4
Enter Phone Number of Technician 4
Enter Name of Technician 5
Enter Email of Technician 5
Enter Phone Number of Technician 5
Enter Name of Technician 6
Enter Email of Technician 6
Enter Phone Number of Technician 6
Enter Name of Technician 7
Enter Email of Technician 7
Enter Phone Number of Technician 7
Enter Name of Technician 8
Enter Email of Technician 8
Enter Phone Number of Technician 8
Enter Name of Technician 9
Enter Email of Technician 9
Enter Phone Number of Technician 9
Enter Name of Technician 10
Enter Email of Technician 10
Enter Phone Number of Technician 10
Enter Name of Technician 11
Enter Email of Technician 11
Enter Phone Number of Technician 11
Enter Name of Technician 12
Enter Email of Technician 12
Enter Phone Number of Technician 12
Enter Name of Technician 13
Enter Email of Technician 13
Enter Phone Number of Technician 13
Enter Name of Technician 14
Enter Email of Technician 14
Enter Phone Number of Technician 14
Enter Name of Technician 15
Enter Email of Technician 15
Enter Phone Number of Technician 15
Enter Name of Technician 16
Enter Email of Technician 16
Enter Phone Number of Technician 16