| 09/12/2012 |
| 06:01:47 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SCHALAVIM, LURE, | 3H-183101103 | R | 59.00 | 4269********2416 | 766031 | 09/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 59.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 59.00 |