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Get NY NY-07-134

P: b. Contact Information for Business Organization Name: Fax: Title: Phone Number: II. Sole Proprietor Attestation: By executing this document, I hereby attest that: (i) the above described business organization is not an association, group purchasing organization or employee leasing organization and was formed for a lawful business purpose and not for the primary purpose of obtaining group insurance; (ii) I am the owner and operator of the above described business organization; (iii) I wo.

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