| 12/12/2012 |
| 08:49:53 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| NIELSEN, JORDAN, | 3J-004280 | R | 21.95 | 4063********5026 | 571797 | 12/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 21.95 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 21.95 |