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verizon <br /> Invoice Number Account Number Date Due Page <br /> 9771795311 542058966-00001 10/05/16 2 of 30 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $397.29 <br /> Payment—Thank You <br /> Payment Received 08/18/16 —397.29 <br /> Total Payments —$39729 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> SMB UNL Talk&TXT 30GB 09/11 —10/10 225.00 <br /> 22%Access Discount 09/11 —10/10 —49.50 <br /> Subtotal <br /> $175.50 <br /> Total Account Charges and Credits $175.50 <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 5029 Wallingford, CT 0.6.492 _ <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 /> agreement does not alltteerlthe termswill <br /> ofyournotified <br /> existi g Customer Agreement.I agree that Verizondebit <br /> Wieless not liable for erroneouin advance of the s statements orunderstand <br /> incorrect debits to my account.Thiso <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 /> UDI <br /> 1 ■ <br /> 0003101-0065870.0000002 of 0000054-C23-FL-6510-03104 <br />