| 01/29/2014 |
| 08:30:23 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MENDES, HECTOR, | A3-MEDICAL373 | R | 208.00 | 5143********6312 | 000517 | 01/29/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 208.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 208.00 |