| 12/12/2012 |
| 08:49:53 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| WIEGMANN, DEANN, | 3Q-002298 | R | 110.74 | 5307********9759 | 612601 | 12/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 110.74 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 110.74 |