| 09/12/2012 |
| 06:03:13 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| LOPEZ, KRYSTAL, | GZ-555990 | R | 19.99 | 4447********1814 | 012586 | 09/12/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 19.99 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 19.99 |