| 12/07/2011 |
| 11:14:37 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| BALCOM, LEE, | 4Z-007105 | R | 79.00 | 4717********3437 | 121181 | 12/07/11 |
| 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 |