| 11/21/2012 |
| 08:57:33 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ROMERO, WILLIE, | AZ-11360 | R | 50.00 | 4190********2289 | 000636 | 11/21/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 50.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 50.00 |