| 11/14/2012 |
| 08:47:24 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| CHAMBERS, JACK, | QM-115811 | R | 39.99 | 4495********1445 | 336458 | 11/14/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 39.99 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 39.99 |