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verizon ' <br /> Invoice Number Account Number Date Due Page <br /> 97r0,8,919100 , 8722g8827-00001 07/05/16 2 of 5 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+ SEND #BAL+SEND <br /> Payments <br /> Previous Balance $266.06 <br /> Payment-Thank You <br /> _ Payment Received 06/02/16 -266.06 <br /> Total Payments -$266.06 <br /> Balance Forward $.00 <br /> 11 <br /> MIN <br /> Written,natatten payment will not be•reealtetela•or b nored.Please send correspondence to: <br /> VerLzolf Wire . 4ttn espendent a leant pit Box 501°Wallingford,CT 06492 <br /> Automatic Payment Enrollment for Account:872298827-00001 CITY OF EUGENE-1 MB 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 the payment. I understand and accept these terms. This <br /> agreement does not atter 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 /> II El ■ <br /> 0015603-0055501-0000002 of 0000006-C11-LT-6210-15618 <br />