verizon1 <br /> Invoice Number Account Number Date Due Page <br /> 9762138634 871628793-00001 04/08/16 2 of 19 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $121.64 <br /> Payment—Thank You <br /> Payment Received 02/26/16 —121.64 <br /> Total Payments —$121.64 <br /> Balance Forward $.00 <br /> • <br /> Witten notations included with or on your payment will nofbe reviewed orhonored-Please send correspondence to: . <br /> '• Verizon Wireless Attn. Correspondence Team PO Box 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 /> ❑ <br /> 0002981,006,1252-00 00002 or 0000037-03-11.-5913-02985 <br />