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verizon� <br /> Invoice Number Account Number Date Due Page <br /> g� , 9765296482 971640668 00001 06/05/16 '2 of 8 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $197.89 <br /> Payment—Thank You <br /> Payment Received 04/28/16 —197.89 <br /> Total Payments —$197.89 <br /> Balance Forward $.00 <br /> � <br /> _ or q, Writteo notations mclli'dedwith or on your payment wul not:be reviewed€or honored'Please seritl'corresp ondence to <br /> z' .v�Verizon;Wireless-Attn: Correspondence Team.PO8Box,5029_Wallingford, CT„06492 <br /> Automatic Payment Enrollment for Account:971640668-00001 CITY OF EUGENE-SMB SPRINKLERS <br /> By signing below,you authorize Verizon Wireless to electronicaly 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 /> III El <br /> 001 5868 0056464-000000of 0000U1 0-C11-11-6110-15803 <br />