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• <br /> veriz®n✓ <br /> Invoice Number Account Number Date Due Page <br /> 9755044705 542011189-00001 11/29/15 2 of 14 <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 $895.84 <br /> - Verizon Wireless' Surcharges include (i) a Regulatory Charge <br /> (which helps defray various government charges we pay including Payment-Thank You <br /> - government number administration and license tees); (ii) a Payment Received 10/22/15 —895.84 <br /> - Federal Universal Service Charge (and, it applicable, a State <br /> Universal Service Charge)to recover charges imposed on us by Total Payments —$895.84 <br /> - the government to support universal service; and (iii) an Balance Forward $.Co <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 <br /> • <br /> services; properly 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 /> • <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:542011189-00001 CITY OF EUGENE <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. 1 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 VNreless.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 /> Changing your billing address for Account:542011189-00001 CITY OF EUGENE <br /> Use this space or sign in to My Verizon at vzw.comlchangeaddress to change the mailing address where we send your bill.It we do not have your most recent email address,provide a <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 /> State/Zipstreet address(not a PO Box)that is the home or primary <br /> 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 into My Verizon at vzw.comiserviceaddress. <br /> Email <br /> 0013537-0118998-0000002 of 0000016 C22_Rc-5704-13550 <br />