| 02/10/2016 |
| 09:08:36 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| WEGLARCZYH, JAC, | A1-812028 | R | 25.99 | 4265********6099 | 614341 | 02/10/2016 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 25.99 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 25.99 |