| 09/26/2012 |
| 08:28:37 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| PALENCIA, RAY, | A3-MEDICAL297 | R | 318.00 | 4844********6343 | 055510 | 09/26/12 |
| STUDIVANT, LAMA, | A3-10851 | R | 27.03 | 5109********4564 | H58222 | 09/26/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 27.03 |
| 1 | Visa | 318.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 345.03 |