| 01/23/2013 |
| 07:12:26 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| BURZINSKI, MIRA, | 3H-550259341 | R | 84.00 | 4217********1910 | 002224 | 01/23/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 84.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 84.00 |