| 02/06/2013 |
| 09:15:52 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| NOVACK PERHOS,, | GF-10492 | R | 26.73 | 4022********5810 | 006462 | 02/06/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 26.73 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 26.73 |