Honeywell VISTA-21IP manual Owner’S Insurance Premium Credit Request, A. General Information

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.:

VISTA-21iP /VISTA-21iPSIA________________________________________________ Other

(circle the appropriate model number)

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

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