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verizon <br /> Invoice Number Account NumberZ " <br /> Date Due Page <br /> 9773545567 971640668-00001 11/05/16 2 of 8 <br /> Get Minutes Used - ----- - - - <br /> Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND <br /> #BAL +SEND <br /> Payments <br /> Previous Balance $196.60 <br /> Payment—Thank You <br /> Payment Received 09/26/16 <br /> —196.60 <br /> Total Payments —$196.60 <br /> Balance Forward $.00 <br /> �Y. <br /> N. <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 06492 <br /> Automatic Payment Enrollment for Account:971640665-00001 CITY OF EUGENE-5MB SPRINKLERS <br /> By signing below,you authorize Verizon Wireless to electronically debit <br /> 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 noted each month of the date and amount of the debt 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 <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. my account.To <br /> 3.Return this slip with your payment.Do not send a voided check. <br /> III ❑ <br /> ■ <br /> 0015312-0055073-0000002 of 0000010-C11-LT-6610-15327 <br />