f V4'1'% l>fwireless <br />Invoice Number Account Number Date Due Page <br />F Jr�:���ir' � �v��x "�'c�, a�' � �',�'. ��'. �r`r�¢. i�t:��:�,z��ca.��� s �;° ccu „ .�`aFt\�\�° a�,`�v i✓' <br />,��. t �� �.. '. � a ��,c �'�5£aF, �,��� �T�. �s TT\s ��� ��� � � ^ \�Y'���� �. t���Ul1'�� ��,�''�'U9 ✓ i <br />., ....;:�,.�,�_;.,;:... ��.�..... . „t <,1;;<:, <.v<;�:•.�,,.,,,�,_w�C.<. d .a.Rs F...._..�.....�„ «���z.:u. `aa�,..�..�.... ....,..�::. ���«.>ay� w�....:�� ,a ............... ,.. ._ .... ..., .. '.., ._�... <br />Get Minutes Used <br />Get Data Used <br />Verizon Wireless' Surcharges <br />Verizon Wireless' Surcharges include (i) a Regulatory Charge <br />(which helps defray various government charges we pay including <br />government number administration and license fees); (ii) a <br />Federal Universal Service Charge (and, if applicable, a State <br />Universal Service Charge) to recover charges imposed on us by <br />the government to support universal service; and (iii) an <br />Administrative Charge, which helps defray certain expenses we <br />incur, including charges we or our agents pay local telephone <br />companies for delivering calls from our customers to their <br />customers, fees and assessments on our network facilities and <br />services, and costs and charges associated with new cell site <br />construction, local number portability, and other government <br />mandates. Please note that these are Verizon Wireless charges, <br />not taxes. These charges, and what's included, are subject to <br />change from time to time. <br />Taxes, Governmental Surcharges and Fees <br />Includes sales, excise and other taxes and governmental <br />surcharges and fees that we are required by law to bill <br />customers. These taxes, surcharges and fees may change from <br />time to time without notice. <br />Late Fee Information <br />A late payment applies for unpaid balances. The charge is the <br />greater of $5 or 1.5% per month, or as permitted by law. <br />Verizon Wireless' Other Charges and Credits <br />Includes charges for products and services, and credits owing. <br />Get Balance <br />Previous Balance $1,252.96 <br />Payment — Thank You <br />Payment Received 01/05/12 — 1,252.96 <br />Total Payments — $1,252.96 <br />Balance Forward $.00 <br />Automatic Payment Enrollment for Account: 371628681 -00001 EUGENE -PARKS & OPEN SPACES <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 check for this month's payment. <br />O E M _J <br />Changing your billing address for Account: 371628681 -00001 EUGENE -PARKS & OPEN SPACES <br />Use this space or sign in to My Verizon at www.verizonwireless.com to change the mailing address where we <br />send your bill. If we do not have your most recent email address, provide <br />it below and we'll use it to tell you important information about your Verizon Wireless service. Allow 2 billing cycles for the address change to take effect. <br />New Address <br />PLACE OF PRIMARY USE (PPU) <br />The home or business mailing address indicated to the left <br />City <br />is for the person using the phone(s) and is the person's <br />State/Zip <br />residential street address or primary business address <br />_YES NO If "NO” or for multi -line accounts with <br />Daytime Phone Evening Phone <br />more than one PPU address, please contact our Customer <br />Service Department or visit our website to change the <br />Email <br />user's PPU address. <br />Order #: 3713 Copy #: 05 <br />Control #:40000028- 00001285 <br />