| 10/03/2012 |
| 08:16:48 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| GOLOMBISKY, DAV, | MH-25404 | R | 145.00 | 4327********1193 | 486462 | 10/03/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 145.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 145.00 |