First Alert FA130CP 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:
FA130CP
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
Other ______________________________
Name
Police Dept.
Monthly
continued on other side
Policy No.:
Fire
Serviced by:
Weekly Other
Both
Name
Address
Fire Dept.
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