| 12/12/2012 |
| 08:49:20 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ORTIZ, ELIZABET, | 4M-007019 | R | 64.95 | 5109********7602 | H90060 | 12/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 64.95 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 64.95 |