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OWNER’S INSURANCE PREMIUM

CREDIT REQUEST

rhis form should be completed and forwarded to your homeowner’s insurance carrier for possible premium credit.

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GENERAL INFORMATION:

Insured’s Name and Address:

Insurance Company:

Policy No.:

ADEMCO System: via30+

VISTA 10 411 IXM (circle one)

Type of Alarm:

❑ Burglary

❑ Fire

❑ Both

Installed by:

Serviced by:

nama

addrass

address

NOTIFIES (Insert B for Burglary, F for

Fire, where appropriate):

Local Sounding Device

Police Dept.

Fire Dept.

Central Station

Name and Address:

TESTING:

❑ Quarterly, ❑ Monthly, ❑ Weekly, n Other

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ADEMCO VIA 30+ Guida Utente Pagina 37