| 12/19/2012 |
| 07:07:13 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MARTINEZ, VICTO, | T3-B5987 | R | 39.95 | 5516********6621 | 784373 | 12/19/12 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 39.95 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 39.95 |