Honeywell LYNXR24 Owners Insurance Premium Credit Request, Notifies Insert B = Burglary, F = Fire

Page 46

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:

Policy No.:

ADEMCO LYNXR/LYNXR24__________________________________________					Other
Type of Alarm:		Burglary		Fire

Both

Installed by:					Serviced by:
		Name					Name

		Address					Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device			Police Dept.				Fire Dept.

Central Station

Name:_______________________________________________________________________________

Address:

Phone:

C. POWERED BY: A.C. With Rechargeable Power Supply

D. TESTING:

Quarterly

Monthly

Weekly

Other

(continued on other side)

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Image 46

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