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Veriz®n� <br /> Invoice Number Account Number Date Due Page <br /> - ' '9765427839 871628793-00001.;,06/08 16 2 of 21 <br /> A— �.. .. ... .�.n �...& .- s. v1........� I <br /> Get Minutes Used Get Data Used Get Balance <br /> • <br /> '#MIN+;SEND #DATA+SEND - #BAL+SEND <br /> Payments <br /> Previous Balance $116.14 <br /> Payment—Thank You <br /> Payment Received 05/03/16 —116.14 <br /> Total Payments —$116.14 <br /> Balance Forward $.00 <br /> r—rrWrnten notations mcluded with or.on your payment Willnot be revlewetlror"honor dTPlease send correspondence to <br /> VerizonsWireless"Attn: Correspondence TeamPO 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 noted 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 /> E El <br /> 0002621-0055979-0000002 of 0000032-C23-ILa6113-02623 <br />