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 |
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Both
Installed by: |
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| Serviced by: | ||||
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| Name |
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| Name | ||
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| Address |
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| Address | ||
B. NOTIFIES (Insert B = Burglary, F = Fire) |
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Local Sounding Device |
| Police Dept. |
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| Fire Dept. |
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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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