| 11/14/2012 |
| 09:02:29 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| TRIPLETT, SAMAN, | 5F-007323 | R | 54.00 | 4744********7530 | 174215 | 11/14/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 54.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 54.00 |