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Owner's insurance premium credit request – First Alert FA1220CV User Manual

Page 55

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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.:

FIRST ALERT PROFESSIONAL'S FA1220C ___ FA1220CV ____

Other

Type of Alarm:

Burglary

Fire

Both

Installed by:

Serviced

by:

Name

Name

Address

Address

B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device

Police Dept.

Fire

Dept.

Central Station

Name:

Address:

Phone:

C. POWERED BY: A.C. With Rechargeable Power Supply

D. TESTING:

Quarterly

Monthly

Weekly

Other

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