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verizon Rir:41El <br /> Invoice Number Account Number Date Due Page <br /> 9777021503 871628793-00001 01/08/17 2 of 43 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN +SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $511.68 <br /> Payment—Thank You <br /> Payment Received 11/28/16 —511.68 <br /> Total Payments —$511.68 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> MORE EVERY UNL TLK&TXT 10GB 12/14—01/13 100.00 <br /> 22%Access Discount 12/14—01/13 —22.00 <br /> Subtotal $78.00 <br /> Total Account Charges and Credits $78.00 <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 5029 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account:871628793-00001 EUGENE-PW/MAINTENANCE <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 /> setup Automatic Payment. You will be notified 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 /> ■ El <br /> 0001109 U).199-11 0000007 of 0000064-C24-BK-681 3 01 110 <br />