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verizon <br /> Invoice Number Account Number Date Due Page <br /> 9770142194 542058966-00001 09/05/16 2 0128 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $677.28 <br /> Payment—Thank You <br /> Payment Received 08/05/16 —677.28 <br /> Total Payments —$67728 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> SMB UNL Talk&TXT 30GB 08/11 -09/10 225.00 <br /> 22%Access Discount 08/11 -09/10 -49.50 <br /> Subtotal $175.50 <br /> Total Account Charges and Credits $175.50 <br /> Written notations included with or on your, payment will not bt reviewed or honored.Please send correspond. nce to., <br /> verizen Wireless Corre$pons ne Tea P0 Box i�taiiinp ord,CT n64 <br /> Automatic Payment Enrollment for Account:542058966-00001 CITY OF EUGENE PWM/POS <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 /> ■ ❑ a <br /> 0003078-0065032 0000002 or 0000052-C23-FL,6110-03081 <br />