Prearranged Funeral Contract

Prearranged Funeral Contract with Interment in Cemetery and Statutory Disclosures

This Agreement Provides for Endowment Care

This Agreement is made (date), between , a corporation organized under the laws of , having its principal office at , hereinafter sometimes called the Seller or Funeral Provider, and , of , hereinafter called the Purchaser.

1. Seller agrees to sell and Purchaser agrees to buy the following described Interment Rights, Merchandise, and Services.

PRENEED -- This is a preneed sale, and it is not the intention of the Seller to conduct at-need solicitation of sales for burial rights, merchandise, or services.

This is an unsolicited at-need sale and the Purchaser so certifies.

BUYER'S RIGHT TO CANCEL. You the Purchaser may cancel this contract within days of the date of execution and receive a full refund of all funds paid to the Seller for any burial rights, merchandise, or services not used, by providing written notice to the Seller. You the Purchaser may cancel this contract after days from the date of execution and receive a refund based on the following:

A. For services, facilities and cash advance items: A full refund of all money paid toward the purchase price allocable to such items shall be paid to the Purchaser within days after mailing such request to Seller.

B. For merchandise items: If at the time of need, the Seller, after being notified, cannot deliver the items of merchandise with a reasonable time, a full refund of all money paid toward the purchase price allocable to the specific item or items of merchandise shall be paid to the Purchaser.

C. For interment rights: No refund is available.

1. (Description of burial place)

2. Description of Interment Rights, Merchandise, and Services: (Give Description of interment rights, merchandise, and services)

3. Memorial inscription: (describe memorial inscription)

2. CREDIT DISCLOSURES (Made in Compliance with Federal Law)

A. Total Cash Price $ (dollar amount of cash price)

B. Cash Down Payment $ (dollar amount of down payment)

C. Unpaid Balance of Cash Price $ (dollar amount of unpaid balance)

D. Other Charges $ (dollar amount of other charges)

1. Doc. Stamps (on Amount Financed) $ (dollar amount of stamps)

Total Other Charges $ (dollar amount of other charges)

E. Amount Financed (C+D) $ (dollar amount of amount financed)

F. Finance Charge $ (dollar amount of finance charge)

G. Total of Payments (E+F) $ (dollar amount of total payments)

H. Total Sales Price (A+D+F) $ (dollar amount of total sales price)

Annual Percentage Rate %

Finance Charge

Amount Financed

Total Payments

Total Sale Price

If accepted by Seller, the parties agree to the following terms and conditions:

3. Having first been quoted both a Total Cash Price and a Total Sales Price for the items described above, and for value received, the Purchaser (jointly and severally, if more than one), promises to pay to the order of the Seller, at its address shown above the amount identified above as the Total of Payments in accordance with the payment schedule dates set out above.

4. TRUST DEPOSITS

A. For all services purchased and facilities rented, % of the purchase price collected will be placed into trust. For all cash advance items purchased, % of the purchase price collected will be placed into trust. For all merchandise items purchased, % of the purchase price collected or % of the wholesale cost, whichever is greater, will be placed into trust.

B. For all interment rights sold, % of the purchase price will be placed into trust. No deposit will be less than $ per interment right.

5. For questions or complaints which cannot be resolved with the Seller, contact at .

6. Opening and Closing charges (interment/entombment or inurnment service charges): are not included on the above-referenced contract.

7. If not included: The current price for opening and closing during regular weekday hours, prior to , is $ . This price is subject to change at any time without notice unless purchased with this contract. Additional charges are made for after hours, to , Saturdays, Sundays, and holidays if services are requested by Purchaser during those times or days.

8. The Seller has determined, as of the date of this contract, that the goods indicated on the contract will be accepted at the following cemetery, which is of the Purchaser's choice: .

9. Upon payment of the Total Sales Price by the Purchaser, the Seller agrees to convey to the person(s) designated below the Interment Rights described above.

A copy of this Agreement was delivered to and receipt is acknowledged by each Purchaser.

Purchaser, in addition to authorizing Seller to furnish the Interment Rights, Merchandise, and Services specified above on the terms and conditions set forth in this contract, also acknowledges by his or her signature that before any discussion of selection, a printed or typewritten list specifying Seller's retail price for all of its available Interment Rights, Merchandise, and Services was furnished. Purchaser also acknowledges that this Contract was completed as to all essential provisions before it was signed by Purchaser and a copy was delivered to Purchaser at the time this Contract was signed.

Executed in multiple copies this (date of execution).

Notice to Buyer—Do not sign this agreement before you read it or if it contains any blank spaces. You are entitled to an exact copy of the contract you sign. Keep it to protect your legal rights.

Accepted: