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verizon' <br /> Invoice Number Account Number Date Due Page <br /> 9760327002 742058933-00001 03/05/16 2 of 42 <br /> • <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $555.56 <br /> Payment-Thank You <br /> Payment Received 02/01/16 -555.56 <br /> Total Payments -$555.56 <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 included with or on your payment will not be review`eli CT-honored. Please sendcorrespondepce to: � <br /> _'Vernon Wireless Attn:.Correspondence Team.PO Box 5029 Wallingford,GT 06492 <br /> Automatic Payment Enrollment for Account:742058933-00001 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 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 /> • <br /> 0003752-0080112-0000802 of 0000058-C23-II-5810-03755 <br />