First Alert FA1620 User Manual page 43

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:
First Alert
Professional FA162C
Type of Alarm: Burglary
Installed by:
Name
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Alarm Monitoring Company
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly
Other _____________
Fire
Serviced by:
Police Dept.
Name:
Address:
Phone:
Monthly Weekly
(continued on other side)
– 43 –
Policy No.
Both
Name
Address
Fire Dept.
Other