First Alert Owners Insurance Premium Credit Request, First Alert System Model FA145C

Models: FA145C

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OWNER'S INSURANCE PREMIUM

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: Model FA145C

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: A.GENERAL INFORMATION:First Alert System: Model FA145C Quarterly, – 37 –Manual background Monthly, Manual backgroundManual background Weekly,

Other _____________________________________________

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First Alert user manual Owners Insurance Premium Credit Request, First Alert System Model FA145C, A.General Information