Trusted Form

Lead Verification Details

Securely captured and verified lead information

This lead has been verified and consent recorded.

Contact Information

First Name

Mary E

Last Name

Nier

ZIP Code

13601

State

NY

Date of Birth

1955-10-10

Verification Log

TokenLT-MVGSINNR-AFL6EM
Submitted10/20/2026, 2:40:21 PM
IP Address175.107.245.96
Time on Form34s
Consent✓ Recorded