| 10/16/2013 |
| 08:32:13 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| BETTENCOURT, BR, | 4J-002724 | R | 5.00 | 4190********5289 | 016572 | 10/16/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 5.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 5.00 |