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verizon" <br /> Invoice Number Account Number Date Due Page <br /> 9760352353 • 872298827-00001 103/05/16 2 of 4 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $266.06 <br /> Payment—Thank You <br /> Payment Received 01/25/16 —266.06 <br /> Total Payments —$266.06 <br /> Balance Forward $.00 <br /> .._ <br /> Wrtten-notations mcludetl�withoi on your payment-wtil notbe�"reviewed"o>r:honored-Plisse send"correspondence to - I <br /> Wireless'Attni;Correspondence Team_PU Box_5029:Wallingford,CT406492 <br /> Automatic Payment Enrollment for Account:872298827-00001 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 /> El <br /> 0023734-0084347-0000002 of 0000006-CI 141-$010-23757 <br />