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verizoni <br /> Invoice Number Account Number Date Due Page <br /> • 9765389971 371628681-00001 06/08/16 2 of 72 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $598.28 <br /> Payment—Thank You <br /> Payment Received 05/03/16 —598.28 <br /> Total Payments —$598.28 <br /> Balance Forward $.00 <br /> • <br /> i_ Written notatw`ns Includetl with or on your payment willnot 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:371628681-00001 EUGENE-PARKS S OPEN SPACES <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 /> ® ❑ ■ <br /> • <br /> 00011770)001037-0000002 of IXKKID94-C24-0K-6113,01128 <br />