| 10/14/2015 |
| 08:49:12 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| PAZ-URBINA, DOU, | HW-33524 | R | 166.00 | 4737********4761 | 902619 | 10/14/15 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 166.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 166.00 |