| Street | 44-1 Mukaishinkura | ||
| City/Town | 白河市 | ||
| State/Province/Region | 福島県 | ||
| Zip/Postal Code | 961-0942 | ||
| Phone Number | 0248-23-2230 | ||
| Country | Japan |
| Full Name | 工藤 千代 | ||
| Gender | female | ||
| Birthday | 2000-09-29 | ||
| Social Security Number |
| Credit card brand | Voyager | ||
| Credit card number | 8699899589269228 | ||
| Expire | 2030/5 | ||
| CVV | 887 |