| 06/04/2014 |
| 08:24:40 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| VIERNOW, DR. JO, | MV-503759 | R | 25.92 | 5491********2082 | 00496P | 06/04/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 25.92 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 25.92 |