| 09/05/2012 |
| 05:56:00 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| OTT, MARILYN, | 67-006371 | R | 99.00 | 5178********4810 | 05113B | 09/05/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 99.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 99.00 |