| 10/17/2012 |
| 06:23:16 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| GUTIERREZ-LARA,, | AZ-11179 | R | 95.00 | 5491********2984 | 01750Z | 10/17/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 95.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 95.00 |