First Alert FA120C - Manual (Page 37)

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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 System: FA120C
Type of Alarm: К К Burglary К К Fire К К Both
Installed by: _________________________________ Serviced by: ___________________________________
name name
________________________________ ___________________________________
address address
B . NOTIFIES (Insert B for Burglary, F for Fire, where appropriate):
Local Sounding Device ________ Police Dept. ________ Fire Dept. _______ Central Station ________
Name and Address: _________________________________________________________________________
C . POWERED BY: A.C. With Rechargeable Power Supply
D . TESTING: К К Quarterly, К К Monthly, К К Weekly, К К Other_________________________________
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