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verizon1 <br /> Invoice Number Account Number Date Due Page <br /> MTM ° + 9765290633 942058818-00001 06/05(16 2 of 29 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $374.76 <br /> • - Payment-Thank You <br /> Payment Received 05/03/16 -374.76 <br /> Total Payments -$374.76 <br /> Balance Forward $.00 <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 /> • <br /> ::-!Witten notations Includedwith.oronyour payment will not be.revlewedo}-Yionored Please send correspondence to r- <br /> Verizon Wireless,Attn;_Correspondence Team PO Boz.5029 Wallingford, CT-06492 <br /> Automatic Payment Enrollment for Account:942058818-00001 CITY OF EUGENE PWM/POS <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 /> 0003019 0064158 0W0002 of 0000054-C23-1LL1 10 03022 <br />