| 10/02/2013 |
| 07:28:41 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SAM, ROUTH, | FP-435330 | R | 31.95 | 4342********4849 | 562969 | 10/02/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 31.95 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 31.95 |