| 09/29/2021 |
| 07:08:25 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| MATA, KATHERINE, UNDEFINED | C4-601180 | R | 39.95 | 5312********2167 | 114076 | 09/29/2021 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 1 | MasterCard | 39.95 |
| 0 | Visa | 0.00 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 39.95 |