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verizonV <br /> Invoice Number Account Number Date Due Page <br /> _.._ 9761962478 742058933-00001 04/05/16 2 of 40 1 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND • <br /> Payments <br /> Previous Balance $519.65 <br /> Payment-Thank You <br /> Payment Received 02/26/16 -519.65 <br /> Total Payments -$519.65 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> SMB UNL Talk&TXT 30GB 03/11 -04/10 225.00 <br /> 22%Access Discount 03/11 -04/10 -49.50 <br /> Subtotal $175.50 <br /> Total Account Charges and Credits $175.50 <br /> -- Written notations includetl with oton yourpayment will not be reviewed or honored. Please send correspondence to —fl <br /> ___ Venzon Wireless Attn: Correspondence_Team PO lioak v5029 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account:742058933-00001 CITY OF EUGENE Y j <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 /> • 0 1111 <br /> )31.14-0073525-0yxicc2 of 00130056-0341:5910 03447 <br />