| 10/27/2021 |
| 07:46:57 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| DOMINGUEZ, SAMA, UNDEFINED | 94-FF5025 | R | 29.00 | 4117********4373 | 163952 | 10/27/2021 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 29.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 29.00 |