| 09/21/2011 |
| 08:20:35 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SHARPELYUK, KAT, | 2D-004397 | R | 29.00 | 4190********2099 | 018541 | 09/21/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 29.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 29.00 |