Owner's Insurance Premium Credit Request - Honeywell LYNX Touch Security System User Manual

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:
LYNX Touch Series _________________________________________________
Type of Alarm: Burglary
Installed by:
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Central Station Name: _______________________________________________________________________________
Address:
Phone:
C. POWERED BY:
A.C. With Rechargeable Power Supply
D. TESTING:
Quarterly
Fire
Name
Address
Police Dept.
Monthly
(continued on other side)
– 85 –
Policy No.:
Other
Both
Serviced by:
Name
Address
Fire Dept.
Weekly Other