Please tell us the reason that you need a replacement certificate?

Original Certificate:

Lost
Number Error
Type of Device Error
Model Number or Name Error
Manufacturer Assigned Serial #(s) Error
Date Certification Testing Was Completed Error
Acknowledgement/Notary Error
(Other)

Other:

Tell us the following information about the unit that you are requesting a replacement certificate for:

Type of Speed Measurement Device

Radar
Lidar



br

br

MSMTF Tag Identification Number (e.g. ND-03-222)

[**FIELD MUST BE FILLED IN**]

Manufacturer of the Unit

Applied Concepts, Inc.
Decatur Electronics, Inc.
Kustom Signals, Inc.
Laser Technology, Inc.
MPH Industries, Inc.

Model of the Unit

Manufacturer Assigned Serial Number of the Counting Unit 

Enter any additional comments in the space provided below:

Tell us how to get in touch with you:

Name    

Police Agency    

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City   

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ZIP Code    

E-mail

Telephone Number

FAX Number

Do you need us to fax you a copy of the replacement certificate?

No Thanks
Yes, but no hurry
Yes, ASAP (needed for court)

Please contact me as soon as possible regarding this matter by

No Thanks
Telephone
Fax
Email