Receipt

Order ID: INT141230-4626-94509B
Order Created: December 30, 2014
Paid In Full: December 30, 2015

Purchaser

Ray Myrtle
4695 W 6th Ave
Vancouver, BC V6R1V6
Canada

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

Seller

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

questionacharge.com
BN 76324 2542 PST-1445-0210

Description Quantity Sales Tax Amount
JotForm Premium Yearly
Billed yearly. Next Billing Date On 12/29/15
1 US$0.00 US$90.00
Discount - US$45.00
Subtotal US$45.00
Sales Tax (0%) US$0.00
Total US$45.00