Receipt

Order ID: INT180817-5361-62776B
Order Created: August 17, 2018
Paid In Full: August 17, 2018

Purchaser

Brian Bitler
Harvest Bible Chapel Lancaster
651 Lampeter Road
Lancaster, PA 17602
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 yearly. Next Billing Date On 8/16/18
1 $1.14 $19.00
Subtotal $19.00
Sales Tax (6%) $1.14
Total $20.14



Refunds and Returns
( Returned Amount / Returned Tax Amount )
August 17, 2018 16:25:58 Refund : $19.00 / $1.14 from JotForm Bronze Monthly -$20.14