| Street | Mathesiova 125 | ||
| City/Town | Jachymov | ||
| State/Province/Region | Karlovy Vary | ||
| Zip/Postal Code | 362 51 | ||
| Phone Number | 603 486 537 | ||
| Country | Czech Republic |
| Full Name | Ivana Chlupová | ||
| Gender | female | ||
| Birthday | 1970-04-11 | ||
| Social Security Number | 193-52-3572 |
| Credit card brand | American Express | ||
| Credit card number | 345100449209529 | ||
| Expire | 2028/12 | ||
| CVV | 442 |