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verizon1 <br /> Invoice Number Account Number Date Due Page <br /> 9766938486 971640668-00001 07/05/16 2 of 8 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $196.60 <br /> Payment—Thank You <br /> Payment Received 06/02/16 —196.60 <br /> Total Payments —$196.60 <br /> Balance Forward $.00 <br /> Written notations incluied with Or on your payment will not he- �CB <br /> red.orhonored=Please "+dnrre$lden <br /> Verizon Wirele Attn:Correspondence"Tea*'Pct Box 5029 Wallingford,CT <br /> X92 <br /> Automatic Payment Enrollment for Account:971640668-00001 CITY OF EUGENE-5MB SPRINKLERS <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 /> El ■ <br /> 0015607 0055521-0000002 of 0000010-C1 1-LT-6210 15622 <br />