| 11/21/2012 |
| 08:47:51 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| NELSON, ALISSA, | 4C-013751 | R | 5.00 | 5146********2128 | 373462 | 11/21/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 5.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 5.00 |