First Alert FA1340C-UL User Manual page 61

OWNER'S INSURANCE PREMIUM CREDIT REQUEST
This form should be completed and forwarded to your homeownet's insurance taker for possible premium credit.
A. GENERAL INFORMATION:
Insured's Name and Address:
II
-convany.
Policy No.:
First Alert Professional's FAXMOC
Other
Type of Alarm: 0 Burglary
q
Fire
cl
Both
Name
Serviced by:
Name
Address
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Localt3oun&gDevice
p-Dept
Fire Dept.
Central Station 0 Name:
Address:
Phone:
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: 0
Quarterly
0 Monthly 0 Weekly
q
Other
kontinued on other side)
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