| 07/18/2012 |
| 06:13:51 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| PEREZ, LOURDES, | 5T-005250 | R | 99.00 | 3727*******3014 | 124921 | 07/18/12 |
| Count | Card Type | Total |
| 1 | American Express | 99.00 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 99.00 |