| 12/19/2012 |
| 07:04:49 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| FITZMORRIS, REB, | 4S-102702093 | R | 20.00 | 3743*******2543 | 396019 | 12/19/12 |
| Count | Card Type | Total |
| 1 | American Express | 20.00 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 20.00 |