| 10/29/2014 |
| 06:36:56 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| CARROLL, MATTHE, | A3-MEDICAL97 | R | 99.00 | 5491********9477 | 02974P | 10/29/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 99.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 99.00 |