Filter
Top Products
– 61 –
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.:
FA168CPS / FA148CP
Other ____________________________________________________
(circle the appropriate model number)
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