ADEMCO 4120XM Spezifikationen PDF herunterladen (Seite 53)

OWNER’S INSURANCE PREMIUM

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CREDIT REQUEST

This form should be completed and forwarded to your homeowner’s insurance carrier for possible premium credit.

A. GENERAL INFORMATION:

nsured’s Name and Address

Insurance Company:

ADEMCO Model (placecheckinappropriatebox): 4120XM ❑

rype of Alarm: ❑ Burgla~

❑ Fire

❑ Both

nstalled by:

Serviced by:

Name

Address

B.NOTIFIES (IneettB = Burglary, F = Fire)

.ocal SoundingDevice

Police Dept.

Policy No.:

4140XMP ❑

Name

Address

FireDept.

CentralStation❑ Name:

Address

Phone:

G. POWERED BY: A.C. With Rechargeable Back-up Batte~ Power Supply

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ADEMCO 4120XM Spezifikationen Seite 53