| 10/03/2012 |
| 08:15:58 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| OSIAS, WIDMAYER, | QU-025346 | R | 39.99 | 4155********9968 | 266995 | 10/03/12 |
| 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 |