Approved Order

ORDER REFERENCE # 79402390  from 04/12/2014 07:12

Supplier Product Quantity Total Refunds Chargebacks RDRs
 JotForm Inc JotForm (63462) - Premium Monthly Subscription (1693520)  1  9.95  -  -  -
 Order Total    (Paid via MasterCard : XXXX-XXXX-XXXX- 7613 - BANK OF AMERICA, NATIONAL ASSOCIATION (UNITED STATES))    9.95  -  -  -
 Payment has been fully captured. 
Events
Event Type Amount Date Time Invoice No. ARN 3DS Authentication Result Refund Reason
CHARGE 9.95 04/12/2014 07:12 79402390
Suppliers' Contact Information
Supplier Website Technical Support   General  
 JotForm Inc  http://www.jotform.com  [email protected]  
Note that this action will not close the dispute.
Closure is subject to customer's approval.

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Account Information
 BlueSnap Account Id: 50160718
 BlueSnap Username: 1392214711710
 Name: Kimberly Sandor
 Address: 1224 Mill St, Bldg B
East Berlin, CT 06023
United States
 Shipping Address:
 Email Address: [email protected]  Invoice Contact Information: Kimberly Sandor
377 Research Parkway, Ste 2D
Meriden, CT, 06450
United States
Phone: 203-238-1207 (11)
Email: [email protected]
 Phone: 2032381207