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Ag Group, 2025 South Hughes, Suite 200,TX 79109Date INSUREDS NAME:AGENCY:STREET AND/OR MAILING ADDRESS:ADDRESS:CITY:STATE:ZIP CODE:PHONE:IDENTIFICATION NUMBER:CITY:AGENCY CODE:EFFECTIVE CROP YEAR

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7. If required, attach any supporting documents or proofs as instructed.
8. Review the entire form once again to ensure no mistakes or omissions.
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