| 10/23/2013 |
| 08:27:42 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| KUPKA, DIANA, | RF-6446 | R | 34.00 | 4412********8253 | 016049 | 10/23/13 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 34.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 34.00 |