| 11/16/2011 |
| 09:30:39 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MROZ, MARIA, | 4K-007581 | R | 11.80 | 5120********4951 | R3041Z | 11/16/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 11.80 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 11.80 |