| 12/28/2015 |
| 09:44:21 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| GOMEZ, JASON | G3-728265 | 5 | 84.00 | 4778********8712 | 376682 | 12/28/15 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 84.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 84.00 |