| 10/14/2015 |
| 09:26:58 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| BERGGREN, LORI, | W5-695091 | R | 64.99 | 5178********8149 | 02634B | 10/14/15 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 64.99 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 64.99 |