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verizon1 <br /> Invoice Number Account Number Date Due Page <br /> — <br /> 9760229319 242059101-00004 03/05/16 2 of 29 <br /> Get Minutes Used Get Data Used Get Balance <br /> • <br /> #MIN +SEND #DATA+SEND #BAL+SEND - <br /> Payments and Adjustments <br /> Previous Balance $418.99 <br /> Payment–Thank You <br /> Payment Received 02/01/16 –418.99 <br /> Total Payments –$418.99 <br /> Adjustments <br /> Access Adjustment for 541-731-7904 on 02/01/16 –66.13 <br /> Other Fees and Surcharges –4.38 <br /> Total Adjustments –$70.51 <br /> Credit Balance —$70.51 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> Data SMB 30GB 02/11 –03/10 185.00 <br /> 22%Access Discount 02/11 –03/10 –40.70 <br /> Subtotal $144.30 <br /> Total Account Charges and Credits $144.30 <br /> • Written notations rnclud'ed with.oUr on your payment wilLnot be reviewed or honored. Please correspondence to: <br /> Verrzan Wireless Attn:.Correspondence Team PO Box 5029 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account:242059101-00004 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 debt 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 /> 0003750-00U11054-0000001 of 0000052.C23.rL-50 I 0-03753 <br />