| 10/23/2013 |
| 08:28:06 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| DEROOS, MOLLY, | 5J-007354 | R | 138.00 | 4631********5167 | 905630 | 10/23/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 138.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 138.00 |