Receipt

Order ID: INT121211-6344-67602
Order Created: 11 December 2012
Paid In Full: 11 December 2012

Purchaser

Marius Baltiejus
Klevas Consulting Ltd
Audit House
260 Field End Road
Ruislip, HA4 9LT
United Kingdom

Product Support
https://www.jotform.com
support@jotform.com

Seller

FastSpring
801 Garden Street
Suite 201
Santa Barbara, CA 93101
US

questionacharge.com
VAT Number: 375-3691-65

Description Quantity VAT Amount
JotForm Premium Bi-Yearly
Billed every 2 years. Next Billing Date On 12/10/14
1 US$13.90 US$139.00
Discount - US$69.50
Subtotal US$69.50
VAT (20%) US$13.90
Total US$83.40