| 05/28/2014 |
| 06:32:04 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| JIMENEZ, ELISEO, | HW-122624A | R | 83.00 | 5401********5255 | 01166Z | 05/28/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 83.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 83.00 |