ADT Safewatch QuickConnect Plus User Manual page 43

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:

ADT Safewatch QuickConnect Plus Security System
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
Name
Address
Police Dept.
Monthly
(continued on other side)
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Policy No.:
________________
Fire
Serviced by:
Fire Dept.
Weekly Other
Other
Both
Name
Address