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5T1�}F <br /> verizon <br /> Invoice Number Account Number Date Due Page <br /> 9778562483 971640668-00001 02/05/17 2 of 7 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $196.62 <br /> Payment—Thank You <br /> Payment Received 12/22/16 —196.62 <br /> Total Payments —$196.62 <br /> Balance Forward $.00 <br /> f <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:971640668- 301 CITY OF EUGENE-5MB SPRINKLERS <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 /> ■ ❑ ■ <br /> 0015929-0057539-0000002 of 0000010{11-LT-5710-15944 <br />