Owner's Insurance Premium Credit Request - Honeywell VISTA 15P - Ademco 6 Zone Control Panel User Manual

OWNER'S INSURANCE PREMIUM CREDIT REQUEST

This form should be completed and forwarded to your homeowner's insurance carrier for possible
premium credit.
A. GENERAL INFORMATION:
Insured's Name and Address:
Insurance Company:
VISTA-20P / VISTA-15P
(circle the appropriate model number)
Type of Alarm: Burglary
Installed by:
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Central Station Name:
Address:
Phone:
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly
National Security Systems Inc (800) 457-1999
Other _____________________________________________________
Name
Police Dept.
Monthly
continued on other side
Policy No.:
Fire
Serviced by:
Fire Dept.
Weekly Other
Both
Name
Address
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