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 FA142C System |
|
| |
Type of Alarm: | Burglary | Fire | 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: |
| Quarterly, |
| Monthly, |
| Weekly, |
| Other ___________________________________________ | |
|
|
|
|
| ||||||
|
|
|
|
|
|
| continued on other side | |||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| – 3 7 – | ||
