Trusted Form

Lead Verification Details

Securely captured and verified lead information

This lead has been verified and consent recorded.

Contact Information

First Name

George Manuel

Last Name

Mckenzie

ZIP Code

11203

State

NY

Date of Birth

1954-10-10

Verification Log

TokenLT-MVGRNJIM-1I4W11
Submitted10/20/2026, 2:16:09 PM
IP Address175.107.245.96
Time on Form1935s
Consent✓ Recorded