| 09/28/2016 |
| 07:34:38 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| SEMAN, STEFAN, | Q7-425982 | R | 28.99 | 3767*******1009 | 103960 | 09/28/2016 |
| Count | Card Type | Total |
| 1 | American Express | 28.99 |
| 0 | MasterCard | 0.00 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 28.99 |