Trusted Form

Lead Verification Details

Securely captured and verified lead information

This lead has been verified and consent recorded.

Contact Information

First Name

Carlos

Last Name

Santos

ZIP Code

75801

State

TX

Date of Birth

1956-02-04

Verification Log

TokenFE-MVSB7209-FMJT2K
Submitted10/28/2026, 4:08:40 PM
IP Address58.65.217.146
Time on Form1465s
Consent✓ Recorded