| 10/17/2012 |
| 06:23:18 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SALMERON, ISAAC, | GW-460660 | R | 154.75 | 4021********0254 | 002719 | 10/17/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 154.75 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 154.75 |