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verizon? <br /> Invoice Number Account Number Date Due Page <br /> ' 9760501347. -871628793-00001 03/08/16 2 of 20 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND • #BAL+SEND ' <br /> Payments <br /> Previous Balance $299.97 <br /> Payments-Thank You <br /> Payment Received 01/20/16 -180.62 <br /> Payment Received 02/01/16 -119.35 <br /> Total Payments -$299.97 <br /> Balance Forward $.00 <br /> ._ _ <br /> l Written notations mcllided with or on your paymenC`Will'nofbe reviewed'ol'tionoied-Please'see'send correspondence to ".__ s1 <br /> Verizon:Wireless-Attp_;Correspondence,Team_PO-Bok'5029 Wallingford,CT 06492 . <br /> Automatic Payment Enrollment for Account:871628793-00001 EUGENE-PW/MAINTENANCE <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 /> 0003200-0068803-0000002 of 0000032-C23-f1-5811-03203 <br />