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Verr ilwireless Invoice Number Account Number Date Due Page <br /> 9737167542 871628793 -00001 01/08/15 2 of 19 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN + SEND #DATA + SEND #BAL + SEND <br /> Explanation of Charges Payments <br /> Verizon Wireless' Surcharges Previous Balance $191.97 <br /> - Verizon Wireless' Surcharges include (i) a Regulatory Charge <br /> - (which helps defray various govemment charges we pay including Payment — Thank You <br /> - government number administration and license fees); (ii) a Payment Received 12/03/14 — 191.97 <br /> - Federal Universal Service Charge (and, if applicable, a State - — - <br /> Universal Service Charge) to recover charges imposed on us by Total Payments 4191.97 <br /> the government to support universal service; and (iii) an <br /> Balance Forward. <br /> Administrative Charge, which helps defray certain expenses we <br /> incur, including: charges we, or our agents, pay local telephone <br /> companies for delivering calls from our customers to their <br /> customers; fees and assessments on our network facilities and <br /> services; property taxes; and the costs we incur responding to <br /> regulatory obligations. Please note that these are Verizon <br /> - Wireless charges, not taxes. These charges, and what's included, <br /> are subject to change from time to time. <br /> - Taxes, Governmental Surcharges and Fees <br /> Includes sales, excise and other taxes and governmental <br /> surcharges and fees that we are required by law to bit <br /> customers. These taxes, surcharges and fees may change from <br /> time to time without notice. <br /> Late Fee Information <br /> A late payment applies for unpaid balances. The charge is the <br /> greater of S5 or 1.5% per month, or as permitted by law. <br /> Verizon Wireless' Other Charges and Credits <br /> Includes charges for products and services, and credits owing. <br /> Correspondence Address: Verizon Wireless Attn: Correspondence Team PO Box 5029 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account: 871628793-00001 EUGENE -PW /MAINTENANCE <br /> By signing below, you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account. The check you send will be used to <br /> setup Automatic Payment. You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms. This <br /> agreement does not alter the terms of your existing Customer Agreement. I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account. To <br /> withdraw your authorization you must call Verizon Wireless. Check with your bank for any charges. <br /> 1. Check this box. 2. Sign name in box below, as shown on the bill and date. 3. Return this slip with your payment. Do not send a voided check. <br /> • <br /> [I1I I ■ <br /> Changing your billing address for Account: 871628793 -00001 EUGENE -PW /MAINTENANCE <br /> Use this space or sign in to My Verizon at vzw.com/changeaddress to change the mailing address where we send your bill. If we do not have your most recent email address, provide it <br /> below and well use 8 to tell you important information about your Verizon Wireless service. Allow 2 billing cycles for the address change to take effect. <br /> New Address Confirming or changing your service address <br /> For each of your mobile numbers, in order to bill taxes and <br /> City surcharges correctly we need a service address - which is a <br /> street address (not a PO Box) that is the home or primary <br /> State/Zip _ - business address of the person who uses that number. To <br /> Work Phone Home Phone confirm or change the service address for any of your mobile <br /> numbers, sign in to My Verizon at vzw.com/serviceaddress. <br /> Email <br /> 0001829 - 0040087 - 0000002 of 0000032 -03-FL-6813-01830 <br />