CT# : 00100050
CUSTOMER INFORMATION
Created On : 12/01/2008 Modified On : 2/11/2009
Name : TEST, CUSTOMER Gender : F DOB : 02/01/1970
Addr1 : 2505 S. FINLEY RD. Primary Phone : 985-647-1235 Lang : E
City/St/Zip : LOMBARD/IL/60148 Secondary Phone :   Cust No : CC000000000
Comment :  
MEMBERSHIP SELECTION  
# Ty Memb Bin PCN Group ID Number PC CV Eff Date Term Date
1 P Mem 1     Group 1 494943939     09/12/2008  
2   Mem 2 001553 NHINY2K   989928882     08/08/2007  
                     
                     
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