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verizon" <br /> Invoice Number Account Number Date Due Page <br /> 9768155486 . 542011189-8000 07/30/16 2 of 13 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $932.98 <br /> Payment-Thank You <br /> Payment Received 06/17/16 -932.98 <br /> Total Payments -$932.98 <br /> Balance Forward $.00 <br /> p <br /> Written notations included,with or on your payment.will not be,reviewed or honored.Please.send Correspondence to: <br /> Verizon Wireless Attn:Correspondence Team P0 Box 8029 Wallingford,CT 06492 <br /> Automatic Payment Enrollment for Account:54201118900001 CITY OF EUGENE <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 /> 111 ❑ I <br /> I <br /> 0009139-0083130 0000002 of 0000014 C12-RG-6304-09148 <br />