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<br />Invoice Number Account Number Date Due Page
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<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
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