Insurance Credit Request Form - First Alert FA160C User Manual

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 FA160C
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)
– 47 –
Policy No.
Both
Name
Address
Fire Dept.
Other