Honeywell First Alert FA168CPS User Manual page 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:
FA168CPS / FA148CP
(circle the appropriate model number)
Type of Alarm: Burglary
Installed by:
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Central Station Name:
Address:
Phone:
C. POWERED BY: A.C. With Rechargeable Power Supply
D. TESTING: Quarterly
Other ______________________________________________________
Name
Police Dept.
Monthly
continued on other side
Policy No.:
Fire
Serviced by:
Weekly Other
Both
Name
Address
Fire Dept.
– 61 –