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Verizon <br /> Invoice Number Account Number Date Due Page <br /> • 9763786909'.7' 871628703-00—t00-1.I'(05/08/16 ;2 of18 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND` <br /> Payments <br /> Previous Balance $115.00 <br /> Payment-Thank You <br /> Payment Received 04/01/16 -115.00 <br /> Total Payments -$115.00 <br /> Balance Forward $.00 <br /> • <br /> • <br /> —nrThWritten notation`s InClifded with or on your payment willnot be revlewetl or honored_Please,sendcorrrespondende 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 /> 111 <br /> 0002850 0061175-0000002 of 0000032.C:23-II-6013-02852 <br />