| 09/19/2012 |
| 05:33:16 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| LOPEZ, CARLOS, | 4M-007339 | R | 164.84 | 5491********0903 | 01915B | 09/19/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 164.84 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 164.84 |