| 11/16/2011 |
| 09:30:40 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| TAYLOR, JERMAIN, | 5T-006428 | R | 218.00 | 3717*******6079 | 109420 | 11/16/11 |
| Count | Card Type | Total |
| 1 | American Express | 218.00 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 218.00 |