Ð 3 7 Ð
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: Ê Ê Burglary
Ê Ê Fire
Ê Ê 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:
Ê Ê Quarterly, Ê Ê Monthly, Ê Ê Weekly, Ê Ê Other_________________________________
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Содержание FA120C
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