| 12/30/2015 |
| 06:55:18 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| VIVEROS, ADRIAN, | G3-471914 | R | 19.99 | 3743*******7844 | 209030 | 12/30/15 |
| Count | Card Type | Total |
| 1 | American Express | 19.99 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 19.99 |