Honeywell ADEMCO VISTA-10P User Manual page 53

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:
ADEMCO VISTA-10P/VISTA-10PSIA
Type of Alarm: Burglary
Installed by:
Address
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
Name
Police Dept.
Monthly
continued on other side
Policy No.:
______________________________ Other
Fire
Serviced by:
Weekly Other
Both
Name
Address
Fire Dept.
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