Owners Lnsurancepremlumcredltrequest - ADEMCO 4130XM User Manual

CREDIT REQUEST
This form should be completed and forwarded to your homeowner's insurancf
carrier for possible premium credit.
% GENERAL INFORMATION:
sured's Name and Address:
InsuranceCanparry
Polii No.:
ADEMCO'S VISTA 4140XMP
Type of Alarm: Burglary Fire Both
Installed by: servked by;
name name
address address
B. NOTIFIES
(Insert B= Burglary, F= Fire)
Locale Sounding Device m Police Dept. n Fire Dept. m
Central Station u Name end Address
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly Monthly Weekly Other
E. SMOKE DETECTOR LOCATIONS
Furnace Room Ktchen
•1
Bedrooms
•1
Attic
Basement Living Room Dining Room Hall
F. BURGLARY DETECTING DEVICE LOCATIONS:
Front Door Basement Door RearDcmr All Exterior Doors
Ist Floor Windows
All windows Interior Locations
~
All Accessible Openings, Including Skylights, Air Conditioners and Vents
;. ADDITIONAL PERTINENT INFORMATION:
@natura
Date:
-23-