ADEMCO LYNX User's Guide download pdf (Page 53)

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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 LYNXR-EN ______________________________________ Other

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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ADEMCO LYNX User's Guide Page 53