| 11/28/2012 |
| 08:46:37 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| KLOSS, LORENA, | 3Q-959572143 | R | 53.90 | 4427********5731 | 269660 | 11/28/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 53.90 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 53.90 |