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verizon� <br /> Invoice Number Account Number Date Due Page <br /> 9765152269 242059101-00004 Past Due 2 of 28 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $354.72 <br /> No Payment Received <br /> Total Payments $.00 <br /> Balance Forward Due Immediately $354.72 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> Data SMB 30GB 05/11 —06/10 185.00 <br /> 22%Access Discount 05/11 —06/10 —40.70 <br /> Subtotal $144.30 <br /> Total Account Charges and Credits $144.30 <br /> Written notations included with or on your payment will not be reviewed or honored-Please send correspondence to: <br /> __ __ Verizon Wireless Attn: Correspondence Team PO Box 5029 Wallingford,CT 06492 , <br /> Automatic Payment Enrollment for Account:242059101-00004 CITY OF EUGENE PWM/POS ✓wy' V V✓ <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 dale 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 Vedzon Wireless is nol 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 /> II CI 111 <br /> 000301 A 00 W 733.0000002 of 0000050-C23-F L-6110.03020 <br />