Personal Cremation Package

PERSONAL CREMATION PACKAGE AGREEMENT

Parties and Contact Information

Deceased - Identification

Full legal name of deceased:

Date of birth:

Date of death:

Place of death / facility:

Package Selection and Services

Select the cremation package and additional services to be provided under this agreement:

Fees, Payment and Billing

Base package price: $

Container / alternative container charge: $

Urn charge (if applicable): $

Additional services / fees (transportation, permits, witness fee, etc.): $

Total package price: $

Authorizations, Certifications and Disclosures

I, , as the purchaser and authorizing agent, certify that I am legally authorized to direct disposition of the remains of the deceased identified above and hereby authorize the provider to perform cremation and related services as set forth in this agreement.

I certify that the decedent's body does not contain any hazardous devices, implanted radioactive materials, or other items that could present a safety risk. If there is a pacemaker or implantable device, I have instructed removal prior to cremation and assume responsibility for any failure to remove such devices: I certify removal or absence.

I authorize the provider to take custody of personal property found with the decedent and to follow my instructions below regarding disposition. I understand the provider's limited liability for loss or damage to personal property and agree to the inventory and handling terms described in this agreement.

Disposition of Cremated Remains

Select intended disposition of cremated remains:

If returning to a designated recipient, provide full name and address:

If remains are to be scattered, purchaser acknowledges that scattering is generally irreversible and assumes responsibility for selecting scattering location in compliance with applicable local laws and regulations.

Cancellation, Storage and Unclaimed Remains

Cancellation: Purchaser may cancel this agreement in writing prior to transfer to the crematory. Provider will retain a reasonable administrative fee and will refund the remainder as required by provider policy. Storage: If cremated remains are not collected within 60 days of notification, the provider may assess storage fees and, after reasonable notice, treat remains as unclaimed and dispose of them in accordance with law.

Liability, Indemnification, and Legal Compliance

Provider shall perform cremation in a commercially reasonable manner and in compliance with applicable law. Except as expressly provided herein, provider disclaims all other warranties, expressed or implied. Purchaser agrees to indemnify and hold provider harmless from any claim arising from inaccurate information provided by purchaser, failure to remove medical devices, or purchaser's instructions regarding disposition that violate law.

Purchaser acknowledges that cremation irrevocably destroys the body and that cremated remains are not suitable for scientific testing. Provider's maximum liability for loss or damage to remains or personal property shall be limited to the total fees paid under this agreement, except in cases of gross negligence or willful misconduct.

Miscellaneous

This agreement constitutes the entire understanding between the parties concerning the services described and may be amended only by a written instrument signed by both parties. If any provision is held invalid, the remaining provisions remain in full force. This agreement shall be governed by the laws of the state where the provider performs the cremation.

Acknowledgment

By signing below, I acknowledge that I have read and understand this Personal Cremation Package Agreement, that I have had the opportunity to ask questions and receive answers, and that I authorize the provider to perform the cremation and related services as described.

Witness contact phone:

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