| 09/12/2012 |
| 06:03:11 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| LOPEZ SANCHEZ,, | D9-9617 | R | 33.00 | 4217********3319 | 104607 | 09/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 33.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 33.00 |