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General Information
Restaurant Name		Contact Name
Telephone		Email
Website Address		Type of Entity:	Sole Proprietor Partnership Corporation LLC
Restaurant Street Address		City
State		Zip
Are you a member of the Missouri Restaurant Association?			Yes No
Agent Preference			None Steve Naught Bill Tillotson Jay Jennings Bruce Gentry Darrell Rapp Tim Eastin Jeff Baggett Jim Huffman Phil Ward John T. Hubert Eric Kaup
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