User guide

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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: __________________________________ Policy No.: ____________________
ADEMCO's VISTA-120
Type of Alarm: Burglary Fire Both
Installed by: _______________________________________ Serviced by: _____________________
name name
______________________________________ ______________________
address address
B . NOTIFIES (Insert B for Burglary, F for Fire, where appropriate):
Local Sounding Device__________ Police Dept.___________ Fire Dept. __________
Central Station ________________
Name and Address: _________________________________________________________________
C . POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly, Monthly, Weekly, Other
continued on other side