| 02/19/2014 |
| 06:58:58 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| CARROLL, MATTHE, | A3-MEDICAL97 | R | 110.00 | 5491********9477 | 01989P | 02/19/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 110.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 110.00 |