verizon✓ <br /> Invoice Number Account Number Date Due Page <br /> • 9763631857 872298827-00001 05/05/16 2 of 6 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $340.84 <br /> Payment—Thank You <br /> Payment Received 04/04/16 —340.84 <br /> Total Payments —$340.84 <br /> Balance Forward- $.00 <br /> • <br /> • <br /> • <br /> — . _ _ <br /> I Written notations Included with or on your payment will not be reviewed or honored:Please send correspondence to <br /> I demon Wireless Attn: Correspondence Team PO Box 5029 Wallingford CT 06492y <br /> Automatic Payment Enrollment for Account:872298827-00001 CITY OF EUGENE-1 MB SPRINKLERS <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 leans. 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 /> ■ El11111 <br /> 0020143-0071048-0000002 01 lxxxx108L11-I,T-6010-20163 <br />