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verizon <br /> Invoice Number Account Number Date Due Page <br /> 9773526160 872298827-00001 11/05/16 2 of 4 <br /> Get Minutes Used -- -----�--Get Data Used <br /> Get Balance <br /> #MIN+SEND #DATA+SEND <br /> #BAL+SEND <br /> Payments <br /> Previous Balance $268.06 <br /> Payment—Thank You <br /> Payment Received 09/26/16 <br /> —268.06 <br /> Total Payments <br /> —$268.06 <br /> Balance Forward <br /> $.00 <br /> dal <br /> vc <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, CT0.6.4.9.2 <br /> Automatic Payment Enrollment for Account:872298827-00001 CITY OF EUGENE-1 MB 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. <br /> 3.Return this slip with your payment.Do not send a voided check. <br /> ULIL <br /> ■ <br /> 0015306-0055046-0000002 of 0000006-C11-1J-6610-15321 <br /> p4 <br />