| 12/05/2012 |
| 08:40:06 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| RANGEL, MICHEAL, | A3-MEDICAL289 | R | 110.00 | 5438********9053 | H93603 | 12/05/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 110.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 110.00 |