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verizon <br /> Invoice Number Account Number Date Due Page <br /> 9778542726 872298827-00001 02/05/17 2 of 4 <br /> Get Minutes Used ' Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance $268.06 <br /> Payment—Thank You <br /> Payment Received 12/22/16 —268.06 <br /> Total Payments —$268.06 <br /> Balance Forward $.00 <br /> r <br /> Written notations included with or on your payment will not be reviewed or honored. Please send correspondence to: <br /> ,:_4Y �- Verizon Wireless Attn: Correspondence Team PO Box 5029 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account:872298827-00001 CITY C :UGENE-1 MB 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 /> ■ El 1 <br /> ■ <br /> __ 0015923-0057510-0000002 010000006-01-1J-5710-15938 <br />