Receipt

Order ID: INT150101-3476-12820
Order Created: January 1, 2015
Paid In Full: January 3, 2016

Purchaser

Paul Matusevich
21vek.by
Olshevskogo 22-15
Minsk, 220035
Belarus

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: 102401278

Description Quantity Sales Tax Amount
JotForm Economy Yearly
Billed yearly. Next Billing Date On 12/31/15
1 $0.00 $199.50
Discount - $99.75
Subtotal $99.75
Sales Tax (0%) $0.00
Total $99.75