| 08/21/2011 |
| 08:18:06 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MATOS, LUIS | QM-920694 | R | 29.99 | 4155********9062 | 282910 | 08/21/11 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 29.99 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 29.99 |