| 10/19/2011 |
| 09:23:58 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| WIETRZYKOWSKI,, | 4Y-011706 | R | 69.95 | 4744********4052 | 151747 | 10/19/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 69.95 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 69.95 |