| 12/10/2011 |
| 15:15:14 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| DUEMLER, MADONNA | 4Z-007986 | 2 | 5.00 | 5148********6738 | 916316 | 12/10/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 5.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 5.00 |