verizon1 <br /> Invoice Number Account Number Date Due Page <br /> mm µ 9760288222 . 542058966-00001b3/05/16. 2 of 22 r 4 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance • $268.13 <br /> Payment—Thank You <br /> Payment Received 02/01/16 —268.13 <br /> Total Payments —$268.13 <br /> Balance Forward $.00 <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 /> S ^Wtitten-ootations mcl de'tl with or on your payment will not be revlewetl;o 'honored Pleasesentl correspondence to <br /> Veraon..Wireless, <br /> Attn. Correspondence Team:P.OBox5029:Wallingford.CT 06492, f__... <br /> Automatic Payment Enrollment for Account:542058966-00001 CITY OF EUGENE PWMIPOS <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 <br /> 0003748'0080001-0000002 of 00000400231 I.-5310 03751 <br />