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verizon r•,., x <br /> .. <br /> Invoice Number Account Number Date Due Page • <br /> 9778695476 871628793-00001 02/08/17 2 of 47 <br /> Get Minutes Used --- <br /> Get Data Used 'Get Balance <br /> #MIN+SEND #DATA+SEND <br /> #BAL+SEND <br /> Payments <br /> Previous Balance <br /> Payment—Thank You $488.74 <br /> Payment Received 12/23/16 <br /> Total Payments —488.74 <br /> —$488.74 <br /> Balance Forward <br /> $.00 <br /> Account Charges and Credits <br /> Account Monthly Charges <br /> MORE EVERY UNL TLK&TXT 10GB <br /> 01/14—02/13 100.00 <br /> 22%Access Discount 01/14—02/13 —22.00 <br /> Subtotal <br /> $78.00 <br /> Total Account Charges and Credits <br /> $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 Pa ment 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 debt 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. <br /> 3.Return this slip with your payment.Do not send a voided check. <br /> ID <br /> III <br /> I <br /> i„. <br /> 0001082-0048591-0000002 of 0000070-C24-BK-5713-01083 <br />