| 11/14/2012 |
| 08:47:01 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| LOPEZ, JUAN, | 2G-101415 | R | 21.64 | 5307********3474 | 768761 | 11/14/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 21.64 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 21.64 |