Trusted Form

Lead Verification Details

Securely captured and verified lead information

This lead has been verified and consent recorded.

Contact Information

First Name

Frederick

Last Name

Shamseldin

ZIP Code

75701

State

TX

Date of Birth

1942-06-05

Verification Log

TokenFE-MVSLCYZR-2UYDL7
Submitted10/28/2026, 8:53:12 PM
IP Address58.65.217.146
Time on Form18782s
Consent✓ Recorded