| 09/09/2015 |
| 12:43:10 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| GOLDSCHLAG, DON, | K5-21002492 | R | 84.99 | 3717*******1012 | 163727 | 09/09/15 |
| Count | Card Type | Total |
| 1 | American Express | 84.99 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 84.99 |