| 11/28/2012 |
| 08:48:45 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ROCHA, THERESA, | 17-016115 | R | 29.95 | 4610********0059 | 073109 | 11/28/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 29.95 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 29.95 |