| 10/19/2011 |
| 09:23:59 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MOEN, RACHELLE, | 5L-005606 | R | 69.00 | 5424********7957 | 14331B | 10/19/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 69.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 69.00 |