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�.� verrianlorwass <br />Invoice Number Account Number Date Due Page <br />Get Minutes Used <br />Explanation of Charges <br />Get Data Used <br />Verizon Wireless' Surcharges <br />Verizon Wireless' Surcharges include charges to recover or help <br />defray costs of taxes and of governmental charges and fees <br />imposed on us, including a Regulatory Charge (which helps defray <br />costs of various regulatory mandates, including government <br />number administration and license fees) and a Federal Universal <br />Service Charge (and, if applicable, a State Universal Service <br />Charge) to recover costs imposed on us by the government to <br />support universal service, and may include other charges also <br />related to our governmental costs. It also includes an <br />Administrative Charge, which helps defray certain costs we incur, <br />currently including (I) charges we, or our agents, pay local <br />telephone companies for delivering calls from our customers to <br />their customers, (ii) fees and assessments on network facilities <br />and services, and (iii) certain costs and charges associated with <br />proceedings related to new cell she construction. Please note <br />that these are Verizon Wireless charges, not taxes. These <br />charges, and what's included, are subject to change from time to <br />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 />Payments <br />Previous Balance <br />Payment — Thank You <br />Payment Received 11/07/11 <br />Total Payments <br />Balance Forward <br />Get Balance <br />$1,372.11 <br />— 1,372.11 <br />— $1,372.11 <br />$.00 <br />ling below, you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due an your account. The check you send will be used to <br />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 />rent 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 />rw 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. S. Return this slip with your check for this month's payment. <br />Changing your billing address for Account: 571628681 -00001 EUGENE -PARKS & OPEN SPACES <br />Use this space or sign in to My Verizon at www,verizonvvireless.com to change the mailing address where <br />we 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 />PLACE OF PRIMARY USE (PPU) <br />New Address <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 />residential street address or primary business address <br />State/Zip <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 #:4713 Copy #:05 <br />Control #:40000076- 00003314 <br />