| Street | 10-4 Kanayamacho | ||
| City/Town | 広島市 | ||
| State/Province/Region | 広島県 | ||
| Zip/Postal Code | 7300022 | ||
| Phone Number | 082-241-5922 | ||
| Country | Japan |
| Full Name | 佐々木 篤司 | ||
| Gender | male | ||
| Birthday | 1998-03-16 | ||
| Social Security Number |
| Credit card brand | JCB | ||
| Credit card number | 3556780301750112 | ||
| Expire | 2027/10 | ||
| CVV | 142 |