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verizon <br /> Invoice Number Account Number Date Due Page rx <br /> 9771879750 971640668-00001 10/05/16 2 of 8 <br /> Get Minutes Used Get Data Used <br /> #MIN+SEND Get Balance <br /> #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $196.56 <br /> Payment—Thank You <br /> Payment Received 08/18/16 —196.56 <br /> Total Payments <br /> —$196.56 <br /> Balance Forward $.00 <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 PO Box 502.9 Wallingford, CT 06492 <br /> Automau;. ,r;;ent Enruiunent tor Account:97164,,-,•68-00001 CITY OF EUGENE-5MB SPRINKLERS <br /> By signing below,you authorize Verizon Wireless to electronically debityour 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 /> III Li [ <br /> ■ <br /> ii <br /> 0015097-0054369-0000002 of 0000010-C11-LT-6510-15112 <br />