| 07/24/2013 |
| 07:59:12 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SIWEK, TIFFANY, | 4Y-015879 | R | 39.95 | 5109********1607 | H75197 | 07/24/13 |
| 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 |