ADEMCO 4110XM Bedienungsanleitung PDF herunterladen (Seite 37)

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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 System: 4110DL 4110XM (circle one)

Type of Alarm: Burglary Fire Both

Installed by: _________________________________ Serviced by: ___________________________________

name name

________________________________ ___________________________________

address address

B . NOTIFIES (Insert B for Burglary, F for Fire, where appropriate):

Local Sounding Device________ Police Dept.________ Fire Dept. _______ Central Station ________

Name and Address: _________________________________________________________________________

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

D. TESTING: Quarterly, Monthly, Weekly, Other_________________________________

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ADEMCO 4110XM Bedienungsanleitung Seite 37