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Name:

Address:

City:

State:

Zip:

Phone:

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License #:

Expires:

Agricultural Chemical Solutions

2525 North Shadeland Ave. Box B-14

Indianapolis, IN 46219

For Sales Information Call (317) 891-1146

Invoice to:

INVOICE

Date: 06/13/2024

Invoice #42314-061324

Restricted Use Applicator #

Expiration Date:

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for orders with no shuttles or under $5,000

Item Description Packaging Qty Rate Amount