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: |
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FA168CPS / FA148CP | Other ______________________________________________________ | |||
(circle the appropriate model number) |
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Type of Alarm:
Installed by:
Burglary
Name
Fire
Serviced by:
Both
Name
Address |
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| Address | ||||||||
B. NOTIFIES (Insert B = Burglary, F = Fire) |
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Local Sounding Device |
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| Police Dept. |
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| Fire Dept. |
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Central Station | Name: |
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| Address: |
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| Phone: |
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C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING:
Quarterly
Monthly
Weekly
Other
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