| Street | 37-11 Takagi Higashimachi | ||
| City/Town | 西宮市 | ||
| State/Province/Region | 兵庫県 | ||
| Zip/Postal Code | 662-8567 | ||
| Phone Number | 0798-65-0470 | ||
| Country | Japan |
| Full Name | 廣川 太郎 | ||
| Gender | male | ||
| Birthday | 1991-12-20 | ||
| Social Security Number |
| Credit card brand | JCB | ||
| Credit card number | 3599234277030546 | ||
| Expire | 2031/7 | ||
| CVV | 303 |