Technical Manuals Online! -
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 | |||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
| |||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
continued on other side
