Honeywell LXL-1000 User Manual page 55

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:
LXL-1000/1010
Type of Alarm:
Installed by:
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Monitoring
C. POWERED BY: AC With Rechargeable Power Supply
D. TESTING:
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Other _______________________________
Burglary
Name
Address
Police Dept.
Name:
Address:
Phone:
Quarterly Monthly
continued on other side
Policy No.:
Fire
Serviced by:
Station
Weekly Other
Both
Name
Address
Fire Dept.
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