| 02/16/2017 |
| 08:26:41 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ORTIZ, JAIME, | FD-GV12130812 | R | 29.99 | 4815********9503 | 120134 | 02/16/2017 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 29.99 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 29.99 |