Receipt

Order ID: INT170411-3039-91149
Order Created: April 11, 2017
Paid In Full: April 11, 2017

Purchaser

Misty Dorsey
Revival FIre Ministries
207 Mill Race Drive
Palmer, PA 18045
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 Bronze Monthly
Billed monthly. Next Billing Date On 5/10/17
1 $0.00 $19.00
Subtotal $19.00
Sales Tax (0%) $0.00
Total $19.00