Funeral Services Burial Application

FUNERAL SERVICES BURIAL APPLICATION

RECITALS

WHEREAS, Applicant submits this application to Funeral Provider for the procurement and performance of funeral and burial services, interment, and related merchandise as described herein; and

WHEREAS, Funeral Provider is duly authorized, licensed, and equipped to provide burial, interment, preparation, and cemetery coordination services in accordance with cemetery rules, applicable statutory requirements, and the terms of this Application and Agreement; and

WHEREAS, Applicant desires to engage Funeral Provider to provide the services and merchandise described in this Application and to authorize cemetery interment on behalf of the decedent in accordance with the terms below;

NOW, THEREFORE, Applicant and Funeral Provider agree as follows.

APPLICANT INFORMATION

DECEDENT INFORMATION

Full Name:

Date of Birth:    Date of Death:

SERVICE & INTERMENT DETAILS

Requested Service Type: Funeral Memorial Graveside Private Family

Preferred Service Date:    Preferred Service Time:

Interment Type: Burial Entombment Inurnment (cremated remains)

SCOPE OF WORK

PAYMENT TERMS

Total Contract Amount: $

Deposit Amount (due on execution): $    Balance Due By:

Accepted Payment Methods:

Late Payment Fee: . If unpaid after 30 days, interest and collection costs may be assessed.

Additional Fees: Applicant acknowledges additional cemetery, permit, vault, grave opening, and monument fees may apply and will be invoiced separately. Funeral Provider will obtain prior written authorization for charges exceeding $ without express consent.

TERM AND TERMINATION

Effective Date: . Completion Date: .

Termination: Either party may terminate for material breach if the breach is not cured within days' written notice. Funeral Provider may suspend performance for nonpayment and shall not be liable for delays caused by the cemetery, government authorities, or other third parties.

CONFIDENTIALITY; PRIVACY

The parties shall maintain confidential all non-public personal information and proprietary business information disclosed in connection with this Agreement. Confidential information excludes information that is publicly available, rightfully received from a third party without restriction, or required to be disclosed by law or court order. Funeral Provider may disclose limited decedent information to necessary third parties (cemetery, clergy, government officials) to perform services.

AUTHORIZATIONS, PERMITS AND CERTIFICATIONS

Applicant certifies that they are authorized to arrange the disposition of the decedent and authorizes Funeral Provider to secure required permits, death certificates, transit permits, and cemetery authorizations on Applicant's behalf. Applicant is responsible for providing accurate information and for any fines or penalties resulting from inaccurate or incomplete information.

LIMITATION OF LIABILITY AND INDEMNITY

Except for willful misconduct, Funeral Provider's liability for any claim arising out of this Agreement shall be limited to the total fees actually paid by Applicant for the services giving rise to the claim. Applicant shall indemnify, defend, and hold harmless Funeral Provider and its agents from any claims, damages, costs, or expenses (including reasonable attorneys' fees) arising from Applicant's breach, incorrect information, or acts of third parties engaged by Applicant.

GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the state of without regard to conflict of laws principles.

This Application and Agreement, including any attachments or addenda executed contemporaneously, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior negotiations, proposals, or agreements, whether oral or written. Any amendment must be in writing and signed by both parties.

ACKNOWLEDGMENT AND SIGNATURE

By signing below, Applicant certifies that they have read, understood, and accepted the terms of this Application and Agreement, authorize Funeral Provider to proceed with the services requested, and acknowledge responsibility for payment as set forth herein. Applicant acknowledges receipt of a copy of this executed Application upon request.

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