| 09/22/2021 |
| 07:47:45 |
| Name | Member No. | Cycle | Amount | CC No. | Authorization | Auth. Date |
| ORTIZ, RAFAEL, UNDEFINED | V8-110972 | R | 39.59 | 4599********5042 | H75636 | 09/22/2021 |
| Count | Card Type | Total |
| 0 | American Express | 0.00 |
| 0 | MasterCard | 0.00 |
| 1 | Visa | 39.59 |
| 0 | Discover | 0.00 |
| 0 | Other | 0.00 |
| 39.59 |