| Street | 2201 N Main St | ||
| City/Town | Rockford | ||
| State/Province/Region | Illinois | ||
| Zip/Postal Code | 61103 | ||
| Phone Number | (815) 968-2561 | ||
| Country | United States |
| Full Name | Ellis Altenwerth | ||
| Gender | male | ||
| Birthday | 1982-12-25 | ||
| Social Security Number | 517-49-7883 |
| Credit card brand | Voyager | ||
| Credit card number | 8699197169038174 | ||
| Expire | 2027/4 | ||
| CVV | 857 |