| Street | 4-1 Horikawamachi | ||
| City/Town | 金沢市 | ||
| State/Province/Region | 石川県 | ||
| Zip/Postal Code | 920-0858 | ||
| Phone Number | 076-210-3888 | ||
| Country | Japan |
| Full Name | 青田 加奈 | ||
| Gender | female | ||
| Birthday | 1991-11-30 | ||
| Social Security Number |
| Credit card brand | EnRoute | ||
| Credit card number | 2149729554178691 | ||
| Expire | 2027/10 | ||
| CVV | 302 |