Prearranged Funeral Contract with Interment in Cemetery and Statutory Disclosures This Agreement Provides for Endowment Care This Agreement is made _______________ (date), between _____________________ (Name of
Funeral Provider), a corporation organized under the laws of _____________ (name of state),
having its principal office at __________________________________________________________
________________________ (address of funeral provider), hereinafter sometimes called the
Seller or Funeral Provider, and ________________________ (Name of Purchaser), of __________
________________________________________________________________________________ (address of Purchaser) , 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 _______
(number) 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 ______ (number) 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
_______ (number) 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 paymentC. 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 Finance Amount Total of Total Sale PriceRate Charge (F) Financed Payments (A+D+F)The cost of your The dollar (C+D) (E+F)credit at a yearly amount theThe amount of The amount youThe total amountrate creditcredit provided will have paid your purchase on will cost you to you or on your after you have credit including behalf. made all your down payment payments as scheduled $_____________ (dollar amount of
down payment)________% $__________$________$________$_________(annual percentage (amount of(amount of (amount of (amount of total
rate) finance charge)amount financed) total payments) sales 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 DEPOSITSA.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 ____________
________________ (name of agency) at ______________________________________________
______________________________________ (address of agency).6. Opening and Closing charges (interment/entombment or inurnment service charges):
(description of excluded items) _____________________________________________________
______________________________________ 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 ________ (time of day), 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 _________
(time of day), 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:
______________________________ (name of cemetery) .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).________________________(Name of Purchaser)
______________________________ ______________________________(Address of Purchaser)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:___________________________(Name of Funeral Provider)________________________________By: (Name of Officer of Funeral Provider)__________________________(Title of Officer of Funeral Provider)
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