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verizon1 • <br /> Invoice Number Account Number Date Due Page <br /> 9763508602,...242059101 0000405/05/16 2 of 28 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND • <br /> • <br /> Payments <br /> Previous Balance $364.72 <br /> Payment—Thank You <br /> Payment Received 04101/16 —364.72 <br /> Total Payments —$364.72 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> Data SMB 30GB 04/11 —05/10 185.00 <br /> 22%Access Discount 04/11 —05/10 —40.70 <br /> Subtotal $144.30 <br /> Total Account Charges and Credits $144.30 <br /> --- <br /> c Written notations mclutledwith or on your payment will notfbe7evlewed oThonored"Ple'ase serPB correspondence to <br /> Verizon Wireless Attn: Correspondence—Team—P0 Box 5029 Wallingford CT 06492 <br /> Automatic Payment Enrollment for Account:242059101-00004 CITY OF EUGENE PWM/POS <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 /> 111 111 <br /> 0003241-0069185-0000002 of 0000050-023.11.601 0-07244 <br />