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verizon <br /> Invoice Number Account Number <br /> Date Due Page <br /> 9778555114 942058818-00001 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 $388.47 <br /> Payment-Thank You <br /> Payment Received 12/22/16 <br /> -388.47 <br /> Total Payments <br /> -$388.47 <br /> Balance Forward $.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 /> /44 <br /> R.� <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 ent Enrollment for Account:942058818-00001 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 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. <br /> 3.Return this slip with your payment.Do not send a voided check. <br /> 111 1 <br /> ■ <br /> Ii <br /> (m3216-0068125-0000002 or ocxxinc.r, �� k. <br />