| 10/30/2013 |
| 06:04:35 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| HRYCKOWIAN, DAR, | BD-19867 | R | 35.00 | 4029********8275 | 055804 | 10/30/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 35.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 35.00 |