| 10/24/2012 |
| 09:06:13 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| GAMBILL, CHARLE, | A3-MEDICAL-16 | R | 110.00 | 4694********9934 | 350352 | 10/24/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 110.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 110.00 |