| 12/18/2013 |
| 08:15:48 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| KIRBERGER, DOMI, | AZ-11180 | R | 100.00 | 5109********3198 | H64916 | 12/18/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 100.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 100.00 |