Receipt

Order ID: INT140604-5306-85322
Order Created: June 4, 2014
Paid In Full: June 4, 2014

Purchaser

Zach Walters
Digital Media Communications
140 Dutchman Blvd Suite C
Irmo, SC 29063
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 Monthly
Billed monthly. Next Billing Date On 7/3/14
1 $0.00 $9.95
Subtotal $9.95
Sales Tax (0%) $0.00
Total $9.95