Fill and Sign the Funeral Contract Sample Form

Prearranged Funeral Contract with Appointment of Funeral Director as Attorney-in-Fact to Collect all Burial and Funeral Benefits Agreement made on the ________________ (date) , between _____________________ (Name of Beneficiary) of _______________________________________________________ _____________________ (street address, city, county, state, zip code) , referred to herein as Beneficiary , and _____________________ (Name of Funeral Home) , a corporation organized and existing under the laws of the state of ______________, with its principal office located at ____________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Funeral Director . Whereas, Beneficiary desires to make arrangements in advance for his funeral and to provide funds for the funeral; and Whereas, Funeral Director desires to assure Beneficiary that he will have a funeral in keeping with Beneficiary 's desires and wishes; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Deposit in Savings Account Concurrently with the execution of this Agreement, Beneficiary will deposit $__________ (dollar amount of deposit) in _____________________________ (name of bank) , located at __________________________________________________________ (address of bank) , in a savings account in his own name, as Trustee for the use of Beneficiary , which account shall be used in accordance with the terms and conditions provided in this Agreement. 2. Interest on Account Beneficiary shall have the right to the interest on the account and shall have the right to withdraw any or all of the account balance at any time. 3. Minimum Balance in Account If Beneficiary reduces the account below the balance stated in Section One of this Agreement, Funeral Director shall have the right to terminate this Agreement or to perform its obligations under this Agreement, but to furnish service equal in value to such account balance, plus any funeral or burial benefits that may be available upon the death of Beneficiary . 4. Excess in Account If the total amount of the above-referenced account and all of the funeral and burial benefits exceed the balance stated in Section 1 of this Agreement, Funeral Director agrees to pay any excess to the estate of Beneficiary . 5. Appointment as Attorney-in-Fact Beneficiary authorizes Funeral Director to demand and collect any burial and funeral benefits payable on account of the death of Beneficiary , and appoints Funeral Director as attorney-in-fact, which power shall be coupled with an interest and not revocable by the death of Beneficiary , to collect all claims, demands, property, and rights of every kind and description and apply them to the extent necessary to provide the amount of funds stated in Section 1 of this Agreement. 6. Successor to Funeral Director If Funeral Director shall consolidate or merge, or its operating assets shall be acquired by any other funeral home, the funeral home shall assume the obligations imposed in this Agreement upon Funeral Director , upon the terms and conditions set forth in this Agreement. If the successor business does not agree to assume the obligations, this Agreement shall be terminated. 7. Services to be Furnished If this Agreement shall not be terminated as provided above, Funeral Director agrees to furnish funeral services for the remains of Beneficiary in accordance with the instructions that are attached to and made a part of this Agreement, which services shall be in the following respective amounts:  Casket and services $____________________  Cemetery charges $____________________  Vault $____________________  Minister $____________________  Music $____________________  Flowers $____________________ Transportation $____________________  Notices $____________________  Other $____________________ Total cost of services $____________________ Funeral benefits $____________________ Net deposit $____________________ 13. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 14. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of _____________. 15. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 16. Attorney’s Fees In the event that any lawsuit is filed in relation to this Agreement, the unsuccessful party in the action shall pay to the successful party, in addition to all the sums that either party may be called on to pay, a reasonable sum for the successful party's attorney fees. 17. Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 18. Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 19. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 20. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 21. Counterparts This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. 22. In this Agreement, any reference to a party includes that party's heirs, executors, administrators, successors and assigns, singular includes plural and masculine includes feminine. WITNESS our signatures as of the day and date first above stated. _________________________________ (Name of Funeral Home) By:______________________________ ________________________ __________________________ (Signature of Beneficiary) (P rinted name & Office in Corporation) ________________________ __________________________ (P rinted name) (Signature of Officer)