| 12/21/2011 |
| 07:21:30 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SELF, PATRICIA, | 2R-007862 | R | 79.00 | 4867********3043 | 071407 | 12/21/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 79.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 79.00 |