| 09/28/2016 |
| 07:34:44 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| FORSYTH, SCOTT, | ZQ-703330 | R | 25.99 | 5240********0118 | 05183B | 09/28/2016 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 25.99 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 25.99 |