ADEMCO 4110XM Betriebsanweisung PDF herunterladen (Seite 36)

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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 4110XM

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 __________________________________________________

Address ________________________________________________

Phone __________________________________________________

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

D. TESTING: Quarterly, Monthly, Weekly, Other _______________________

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ADEMCO 4110XM Betriebsanweisung Seite 36