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Verizon <br /> Invoice Number Account Number Date Due Page <br /> 9753825530 ° 971640668-00001 11/05/15 2 of <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND F #DATA 4-SEND #BAL+SEND <br /> Explanation of Charges Payments <br /> Verizon Wireless'Surcharges Previous Balance $363.04 <br /> - Verizon Wireless' Surcharges include (i) a Regulatory Charge <br /> (which helps defray various government charges we pay including Payments—Thank You <br /> government number administration and license fees); (ii) a Payment Received 09/11/15 —181.52 <br /> esirs Federal Universal Service Charge (and, it applicable, a Slate <br /> Universal Service Charge)to recover charges imposed on us by Payment Received 09/24/15 —181.52 <br /> - the government to support universal service; and On an Total Payments —$363.04 <br /> Administrative Charge, which helps defray certain expenses we <br />- incur, including: charges we, or our agents, pay local telephone Balance Forward $.00 <br /> companies tor 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 bill <br /> customers. These taxes, surcharges and tees 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$5 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:971660666-00001 CITY OF EUGENE-SPRINKLERS <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 hill statements or incorrect debits to my account.To <br /> withdraw your authorization you must call Verizon W reless.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 /> M <br /> El <br /> Changing your billing address for Account:971640668-00001 CITY OF EUGENE-SPRINKLERS <br /> Use this space or sign into My Verizon at vzw.conVchangeaddress to change the mailing address where we send your bill.If we do not have your mosl recent email address,provide it <br /> below and we'll use it 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 /> 002815+0102311-0000002 of 0000010 C21-IT 661 0'8182 <br />