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verizon1 <br /> Invoice Number Account Number Date Due Page <br /> 97 78876 971640668-00001 Past Due 2 of 7 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $196.62 <br /> No Payment Received <br /> _ Total Payments $.00 <br /> Balance Forward Due Immediately $196.62 <br /> Written notations included,with or on yq1 payment will not be reviewed or honored.Please'send correspondence to: <br /> Yer i on,YY1 to ttie trespandenc+a Team po Box 502g giatingford eT 06492-----._': <br /> Automatic Payment Enrollment for Account:971640668-00001 CITY OF EUGENE-SMB 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 notified each month of the date and amount of the debit 10 days in advance of thepayment. 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 /> • L1 El <br /> 0015779-0056256-0000002 of0000010-C11-LT-6310-15794 <br />