| 09/18/2013 |
| 06:16:47 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| QUICK, CARL, | A3-MEDICAL54 | R | 133.33 | 4121********8712 | 04641A | 09/18/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 133.33 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 133.33 |