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.: |
LYNX Touch Series _________________________________________________
Type of Alarm: |
| Burglary |
| Fire | ||
Installed by: |
|
|
|
| Serviced by: | |
|
|
| Name |
|
|
|
Other
Both
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)
