| Street | 36/17 ม.2 ซ.ป่าหลาย, ต.ฉลอง จ.ภูเก็ต, 83000 | ||
| City/Town | ภูเก็ต | ||
| State/Province/Region | จังหวัดภูเก็ต | ||
| Zip/Postal Code | 83230 | ||
| Phone Number | 086 470 4953 | ||
| Country | Thailand |
| Full Name | Laverna Wintheiser | ||
| Gender | male | ||
| Birthday | 1983-06-03 | ||
| Social Security Number |
| Credit card brand | Voyager | ||
| Credit card number | 8699916915537639 | ||
| Expire | 2028/9 | ||
| CVV | 066 |