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\ ..— bef i nwire►ess <br /> Invoice Number Account Number Date Due Page <br /> 1119271772 771775989 , 00001 , 1 0/08%12 2of 41 <br /> Get Minutes Used Get Data Used Get Balance <br /> 9 #MIN + -SEND ��. •#DATA';+ SEND, , #BAL +_SEND <br /> Explanation of Charges Payments <br /> Verizon Wireless' Surcharges Previous Balance $1,443.38 <br /> Verizon Wireless' Surcharges include (1) a Regulatory Charge <br /> (which helps defray various government charges we pay including Payment — Thank You <br /> government number administration and license lees); (ii) a Payment Received 09/05/12 — 1,443.38 <br /> Federal Universal Service Charge (and, if applicable, a State <br /> - Universal Service Charge) to recover charges imposed on us by Total Payments — $1,443.38 <br /> - the government to support universal service; and (iii) an Balance Forward $.00 <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 S5 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 /> ", <br /> Correspondence Address iVerizon Wireless` CustomerService 7000 Central Ave SW Albuquerque, NM 87121 2096 <br /> Automatic Payment Enrollment for Account: 771775989 -00001 CITY OF EUGENE PUBLIC WORKS <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 /> ❑ ( I <br /> Changing your billing address for Account: 771775989 -00001 CITY OF EUGENE PUBLIC WORKS <br /> Use this space or sign in to My Verizon at www.verizonwireless.com to change the mailing address where we send your bill. If we do not have your most recent email address, provide <br /> it below and well 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 PLACE OF PRIMARY USE (PPU) <br /> The home or business mailing address indicated to the left <br /> City is for the person using the phone(s) and is the person's <br /> State /Zip residential street address or primary business address <br /> YES _ NO If "NO" or for multi -line accounts with <br /> Work Phone Home Phone more than one PPU address, please contact our Customer <br /> Service Department or visit our website to change the users <br /> Email PPU address. <br /> Order #: 4513 Copy #: 05 <br /> Control #:40000068 - 00002906 <br />