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veriz®n✓ <br /> Invoice Number Account Number Date Due Page <br /> 9760371867 971640668-00001 03/05/16 2 of 7^ <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $378.10 <br /> Payments-Thank You <br /> Payment Received 01/25/16 -181.52 <br /> Payment Received 01/25/16 -196.58 <br /> Total Payments -$378.10 <br /> Balance Forward $.00 <br /> `" Wn n <br /> ritteotatioris"In'cluded with or on your payment will not be,,�evlewed or honored'Please'sefd.correspondence to ' .._. �1 <br /> y e,_,yerizdn Wireless_Attu:SmrespondenceTeameO Box_43029,Wallingford, C,T„06992.,,— r„ <br /> Automatic Payment Enrollment for Account:971640668-00001 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 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 /> 00)1740 0084369-0000002 of 0000010-C1111-5810'3761 <br />