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veru®n✓ <br /> Invoice Number Account Number Date Due Page <br /> w <br /> 9760229316,.. 242059101-00001 03/05/16 2`of77 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND ' <br /> Payments <br /> Previous Balance $740.02 <br /> Payment—Thank You <br /> Payment Received 02/01/16 —740.02 <br /> Total Payments —$740.02 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> ,Account Monthly Charges <br /> SMB UNL Talk&TXT 30GB 02/11 -03/10 225.00 <br /> 22%Access Discount 02/11 —03/10 —49.50 <br /> Subtotal $175.50 <br /> Total Account Charges and Credits $175.50 <br /> Written notations mcludetl Witt or on your payment will not be,reulewed o honored. Please sendcorrespondence to <br /> Verizon Wireless Attn: Correspondence Team PO Box 5029Walhngford CT..06492 <br /> Automatic Payment Enrollment for Account:242059101-00001 CITY OF EUGENE PWM/POS <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 /> 111 111 ■ <br /> 0001590-00/1053 0000002 of 0000088-C21-9K-5/310 01591 <br />