Trusted Form

Lead Verification Details

Securely captured and verified lead information

This lead has been verified and consent recorded.

Contact Information

First Name

Randall

Last Name

Vanausdoll

ZIP Code

43607

State

OH

Date of Birth

1960-12-03

Verification Log

TokenFE-MVS7PR0W-7ZTQP9
Submitted10/28/2026, 2:31:14 PM
IP Address58.65.217.146
Time on Form1137s
Consent✓ Recorded