| Street | 4407 Burrough Rd | ||
| City/Town | Fort Smith | ||
| State/Province/Region | Arkansas | ||
| Zip/Postal Code | 72916 | ||
| Phone Number | (479) 646-2200 | ||
| Country | United States |
| Full Name | Hermina Vandervort | ||
| Gender | female | ||
| Birthday | 1977-06-04 | ||
| Social Security Number | 580-41-3579 |
| Credit card brand | Unionpay | ||
| Credit card number | 6211940215616375 | ||
| Expire | 2028/10 | ||
| CVV | 547 |