| Street | 4701 Southwest Pkwy #20 | ||
| City/Town | Wichita Falls | ||
| State/Province/Region | Texas | ||
| Zip/Postal Code | 76310 | ||
| Phone Number | (940) 696-3985 | ||
| Country | United States |
| Full Name | Laurine Bergstrom | ||
| Gender | female | ||
| Birthday | 2000-04-27 | ||
| Social Security Number | 583-99-1083 |
| Credit card brand | American Express | ||
| Credit card number | 373457426425147 | ||
| Expire | 2028/5 | ||
| CVV | 709 |