• <br /> • <br /> veriz®n✓ <br /> Invoice Number Account Number Date Due Page <br /> 9753955257 :871628793-00001 11/08/15 2 of 25 <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 $191.83 <br />- Verizon Wireless' Surcharges include (i) a Regulatory Charge <br /> (which helps detray various government charges we pay including Payment—Thank You <br />- government number administration and license tees); (ii) a Payment Received 09/30/15 —191.83 <br />- Federal Universal Service Charge (and, if applicable, a State <br /> Universal Service Charge)to recover charges imposed on us by Total Payments —$191.83 <br /> C the government to support universal service; and (iii) an Balance Forward $.00 <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; tees and assessments on our network facilities and Account Charges and Credits <br /> services; properly taxes; and the costs we incur responding to <br />- regulatory obligations. Please note that these are Verizon Account Monthly Charges <br /> Wireless charges, not taxes.These charges, and what's included, <br /> are subject to change from time to time. <br /> Previous Plan <br /> Data Plan 16GB 09/14—09/15 6.00 <br /> Taxes,Governmental Surcharges and Fees $90.00 per month/2 days on plan <br />- Includes sales, excise and other taxes and governmental <br /> surcharges and fees that we are required by law to bill 22°/0 Access Discount 09/14—09/15 —1.32 <br /> customers. These taxes, surcharges and tees may change from Subtotal $4.68 <br /> time to time without notice. <br /> Total Account Charges and Credits $4.68 <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:871628793-00001 EUGENE-PW/MAINTENANCE <br /> By signing below,you authorize Verizon Wreless 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 /> 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 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 /> 000328-1.0070855,0000002 of 0000036-c23-FL,6613,03287 <br />