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verizon <br /> Invoice Number Account Number Date Due Page <br /> ' 9763228142 542011189-00001 04/29!16 '2 o1 15 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $895.88 <br /> Payment—Thank You <br /> Payment Received 04/01/16. —895.88 <br /> Total Payments —$895.88 <br /> Balance Forward $.00 <br /> • <br /> • <br /> 1 Wratten notations mcluded with or on your,payment wlll h6fbe'reviewed or honored;Pleasesend correspondence to <br /> • { <br /> n <br /> i" Vezon Wireless Attn:,Correspontlence Team PO Box 50.2.9 Wallingford,'.CT 06492 r 1 <br /> Automatic Payment Enrollment for Account:542011189-00001 CITY OF EUGENE <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 Venzon Wireless is not fable 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 /> II El <br /> 0010947-009/647.0000002 of 0000016-C12-RG 600440957 <br />