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verizon <br /> Invoice Number Account Number Date Due Page <br /> 9775195946 872298827-00001 12/05/16 2 of 4 <br /> Get Minutes Used Get Data Used <br /> #MIN+SEND Get Balance <br /> DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $268.06 <br /> Payment—Thank You <br /> Payment Received 10/27/16 —268.06 <br /> Total Payments <br /> —$268.06 <br /> Balance Forward $,O0 <br /> • <br /> • <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 06.492 <br />\utomatic Payment Enrollment for Account:872298827-00001 CITY OF EUGENE-1 MB SPRINKLERS <br /> y signing below,you authorize Verizon Wireless to electronically debit <br /> your bank account each month for the total balance <br /> setup Automatic Payment. You will be notified each month of the date and amount of the debit 10 days in advance <br /> due on your account.The check you send will be used to <br /> 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 /> vithdraw 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. <br /> 3.Return this slip with your payment.Do not send a voided check. <br /> Ir1 <br /> 111 <br /> 0015461-0055527-0000002 of 0000006-C11-LT-6710-15476 <br />