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verizonv <br /> Invoice Number Account Number Date Due Page <br /> • 9765250757 742058933-00001. 06/05/16 .2 of 42 • <br /> • <br /> Get Minutes Used Get Data Used Get Balance <br /> MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $533.84 <br /> Payment—Thank You <br /> Payment Received 05/03/16 —533.84 <br /> Total Payments —$533.84 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> _ SMB UNL Talk&TXT 30GB 05/11 —06/10 225.00 <br /> 22%Access Discount 05/11 -06/10 —49.50 <br /> Subtotal $175.50 <br /> Total Account Charges and Credits $175.50 <br /> Written notatiows mcluded with or on your payeentwill not breviewed or honored. Please send correspondence to: <br /> Venioh Wireless-Attn: Correspondence Team PO Boz 5029 Wallingford CT 06492 <br /> Automatic Payment Enrollment for Account:742058933-00001 CITY OF EUGENE <br /> By signing below,you authorize Verizon Wireless to electronically debit your hank 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 lo 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 /> ® ❑ 11/ <br /> • <br /> 0003022-0064244-0000002 of 0000058-Q3•1 r.6110 03025 <br />