First Alert FA142C

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OWNER'S INSURANCE PREMIUM
CREDIT REQUEST (cont.)
E . SMOKE DETECTOR LOCATIONS:
Furnace Room Kitchen Bedrooms Attic
Basement Living Room Dining Room Hall
F . BURGLARY DETECTING DEVICE LOCATIONS:
Front Door Basement Door Rear Door All Exterior Doors
1st Floor Windows All windows Interior Locations
All Accessible Openings, Including Skylights, Air Conditioners and Vents
G . ADDITIONAL PERTINENT INFORMATION:
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Signature: ____________________________________________________ Date: _________________________________