| 10/12/2011 |
| 07:04:18 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| BRENSINE, DELLA, | 21-004290 | R | 69.00 | 3743*******0936 | 794012 | 10/12/11 |
| Count | Card Type | Total |
| 1 | American Express | 69.00 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 69.00 |