| 10/24/2012 |
| 09:03:50 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SAMUELIAN, EMAN, | 3Q-005854 | R | 5.00 | 4366********5301 | 002995 | 10/24/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 5.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 5.00 |