ADEMCO Vista-20 User Manual page 47

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 N ameandAddress:
insuranceCompany:
PolicyNo.:
ADEMCO'S VISTA 20
Other
Type of Aiarm: Burgiaty
Fire
Both
instailedby:
Servicedby
Name
Name
Address
Address
B. NOTIFIES (Insert B = Burgiary, F = Fire)
Local Sounding Device
Poiice Dept.
Fire Dept.
Central Station
C. POWERED BY:
Name:
Address:
Phone:
A.C. With Rechargeable Power Suppiy
D, TESTING: Quarterly
Monthiy
m Weekly Other
oontinued on otherside
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