Applicant Information Hidden Business Address
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Business Information Markets Served by Applicant Describe Applicant’s Main Products/Services Agreements for Participation
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Certification of Applicant
I certify that I have reviewed the preceding statements and any attached supporting documentation, and to the best of my knowledge, the information provided is true, accurate, and complete. I also certify that I have the authority to execute this application on behalf of the applicant.
Reference herein to, or registration by, any specific commercial entities, trade names, trademarks or service marks, or otherwise, does not constitute or imply its endorsement, recommendation, a promise of future employment or work, or favoring by the Iowa Secretary of State or the State of Iowa.
Person Authorized to sign on behalf of business