Receipt

Order ID: INT140513-8898-53562
Order Created: May 13, 2014
Paid In Full: May 13, 2014

Purchaser

Alton Richardson
ARBusinessEnterprise
316 Peters Street
Atlanta, GA 30313
United States

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

Seller

FastSpring
801 Garden Street
Suite 201
Santa Barbara, CA 93101

questionacharge.com
W-9 Form

Description Quantity Sales Tax Amount
JotForm Premium Bi-Yearly
Billed every 2 years. Trial Until 5/12/16
1 $0.00 $139.00
Subtotal $139.00
Sales Tax (0%) $0.00
Total $139.00



Refunds and Returns
( Returned Amount / Returned Tax Amount )
May 22, 2014 17:17:27 Refund : $139.00 / $0.00 from JotForm Premium Bi-Yearly -$139.00