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Name:

Address:

City:

State:

Zip:

Phone:

Email:

License #:

Expires:

Agricultural Chemical Solutions, Inc.

6525 East 82nd Street Suite 210M

Indianapolis, IN 46250

For Sales Information Call (317) 891-1146

Date: 09/25/2023

Invoice #79435-092523

Restricted Use Applicator #

Expiration Date:

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for orders with no shuttles or under $5,000

Item Description Packaging Qty Rate Amount