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verizon1 <br /> Invoice Number Account Number Date Due Page <br /> 9763651385. . 971640668-00001' 05/05/16 2 of 8 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $421.26 <br /> Payment—Thank You <br /> Payment Received 04/01/16 —421.26 <br /> Total Payments —$421.26 <br /> Balance Forward $.00 <br /> • 'Written notations included with or on your payment.will not be reviewed—el-honored:Please send correspondence to: ' <br /> __Venzon Wireless Attn_Correspondence Team PO Boz 5029 Wallingford CT x6492 <br /> Automatic Payment Enrollment for Account:971640668-00001 CITY OF EUGENE-5MB 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 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 /> 0020147.0071068-0000002 of 0000010-C11-1.1-6010-20167 <br />