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. ,f,. <br /> verizon <br /> Invoice Number Account Number Date Due Page <br /> 9778416092 242059101-00003 02/05/17 2 of 31 <br /> Get Minutes Used ----- <br /> Get Data Used <br /> #MIN+SEND Get Balance <br /> #DATA+SEND #BAL +SEND <br /> Payments <br /> Previous Balance <br /> Payment—Thank You $789.60 <br /> Payment Received 12/22/16 <br /> Total Payments —789.60 <br /> Balance Forward —$789.60$.00 <br /> $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> Data SMB 30GB 01/11 —02/10 185.00 <br /> 22%Access Discount 01/11 —02/10 —40.70 <br /> Subtotal . — <br /> $144.30 <br /> Total Account Charges and Credits <br /> $144.30 <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 P 0 Box 5029 Wallingford, CT 06492 <br /> Automatic Pa ment Enrollment for Account:242059101-00003 CITY OF EUGENE PWM/POS <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 noted each month of the date and amount of the debt 10 days in advance of the payment. I understand and accept these terns. 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 /> III • <br /> ❑ <br /> ■ <br /> 0003213-006803 9-0000002 of 000005&Q3-H-571 nln•,,, <br />