Owner's Insurance Premium Credit Request - Honeywell ADEMCO LYNXR-I Security System 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:
ADEMCO LYNXR-I
Type of Alarm: Burglary
Installed by:
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
______________________________________ Other
Name
Address
Police Dept.
Monthly
(continued on other side)
– 53 –
Policy No.:
Fire
Serviced by:
Fire Dept.
Weekly Other
Both
Name
Address