| 01/30/2013 |
| 08:23:40 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| FORET, JAN, | K4-05191 | R | 53.41 | 5528********2968 | 08482Z | 01/30/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 53.41 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 53.41 |