| 12/12/2014 |
| 09:59:54 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ORTIZ, VISIA | SA-A101074 | 2 | 280.00 | 4164********4716 | 04016F | 12/12/14 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 280.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 280.00 |