| 12/05/2012 |
| 08:39:30 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| CHRISTOPHER, DO, | SJ-WEB420994 | R | 27.06 | 3767*******1006 | 104820 | 12/05/12 |
| MUNOZ, ISABEL, | SJ-WEB814217 | R | 27.06 | 4060********2567 | 062709 | 12/05/12 |
| Count | Card Type | Total |
| 1 | American Express | 27.06 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 27.06 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 54.12 |