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Owner’s Insurance Premium Credit Requested
This form should be completed and forwarded to your homeowner’s insurance
carrier for possible premium credit.
carrier for possible premium credit.
This control is UL Listed for: UL Grade A Household Burglary
UL Household Fire
A. General Information:
Insured’s Name and Address
Insurance Co.
Policy No:
Moose Security System
Type of Alarm:
Burglary
Fire
Both
Installed by:
Serviced by:
B. Notifies (Insert B=Burglary, F=Fire)
Local Sounding Device:
Police Dept.
Fire Dept.:
Central Station:
Name and Address:
C. Powered By:
A.C. With Rechargeable Power Supply
D. Testing
Quarterly
Monthly
Weekly Other
(Continued on Reverse)