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verizon <br /> Invoice Number Account Number <br /> Date Due Page <br /> 9778514957 742058933-00001 02/05/17 2 of 46 <br /> Get Minutes Used <br /> Get Data Used <br /> Get Balance <br /> #MIN+SEND #DATA+SEND <br /> #BAL+ SEND <br /> IPayments <br /> ° Previous Balance $65334 <br /> Payment—Thank You <br /> Payment Received 12/22/16 —653.34 <br /> Total Payments —$653.34 <br /> Balance Forward $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> SMB UNL Talk&TXT 30GB 01/11 —02/10 225.00 <br /> 22%Access Discount 01/11 —02/10 —49.50 <br /> Subtotal <br /> $175.50 <br /> Total Account Charges and Credits <br /> $175.50 <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 50.29 Wallingford, CT 06492 <br /> Automatic Payment Enrollment for Account:74205893: :001 CITY OF EUGENE <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 debit 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. 3.Return this slip with your payment.Do not send a voided check. <br /> ■ ❑ l <br /> I ■ <br /> 0001203-0052941-0000002 of 0000064-C24-13K-5710-017n4 <br />