Revocable Preneed Funeral Service Contract

Revocable Preneed Funeral Service Contract

CONTRACT NO.

This Pre-Need Funeral Service Contract, signed this day of 20

by and between Funeral Home, Inc. (hereinafter referred to as “Seller”) and

SSN (hereinafter referred to as the “Purchaser”) is subject to the laws of the State of Connecticut and the following covenants:

1. The beneficiary of the contract is of SSN

2. The Seller agrees to sell and provide and the purchaser agrees to purchase in accordance with the terms and conditions of this contract the professional services and merchandise specifically set forth on the attached Statement of Merchandise and Services Selected which is incorporated into this Contract and made a part of this Contract.

3. Purchaser agrees that the provisions contained on the page entitled, “General Provisions”, shall constitute a part of this agreement and shall be incorporated herein.

THE ESCROW AGENT FOR THIS CONTRACT IS:

Access Financial Group, Inc. 118 N. Clinton Street, Suite 250

Interment Trust Service Chicago, IL 60661

Purchaser acknowledges receipt of a completely filled in copy of this Contract and that they have received or have reviewed the Seller’s Price List in accordance with the FTC Funeral Service Trade Regulation.

For Mailing Purposes:

Name Phone

Address

NOTE: IF THIS AGREEMENT IS SIGNED AT THE HOME OF THE PURCHASER OR AT SOME PLACE OTHER THAN THE SELLER’S PLACE OF BUSINESS, THEN THE PURCHASER IS ENTITLED TO THE FOLLOWING NOTICE AND HAS THE FOLLOWING RIGHTS UNDER CONNECTICUT LAW:

YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.

Revocable Funeral Contract General Provisions

1. CONTENTS OF FUNERAL SERVICE CONTRACT: The FUNERAL SERVICE CONTRACT shall contain: (a) a STATEMENT OF MERCHANDISE AND SERVICES SELECTED, (b) the CONTRACT, (c) GENERAL PROVISIONS, (d) a CERTIFICATE OF OWNERSHIP, and (e) a FINANCING STATEMENT if the Contract is an installment sale.

2. ESCROW ACCOUNT: In accordance with the law of the State of Connecticut, within 15 days of receipt of payment, Seller will deposit in escrow, with an authorized institution, which will serve as escrow agent, 100% of each net payment as made by Purchaser for prepaid funeral services and/or merchandise to be performed or delivered at the time of the beneficiary’s death, exclusive of counseling, finance, interest or other charges. All interest earned on the escrow account, less administrative expenses, shall remain in the account. Purchaser shall receive an annual statement of the amount credited to his/her escrow account. Purchaser irrevocably designates Seller as Purchaser’s Agent with respect to the investment of said account and all matters pertaining to same and the escrow agent holding the escrow account shall be permitted to follow all lawful instructions of Seller. The Seller shall furnish the escrow agent with the name, address and social security number of the Purchaser, name, address and social security number of the Beneficiary of this contract, and the amount of the contract.

3. ANNUAL STATEMENT OF ACCOUNT: Each party to this FUNERAL SERVICE CONTRACT shall receive an annual report from the escrow agent.

4. INVESTMENT OF ESCROW ACCOUNT: All investments shall be made in accordance with Connecticut law. Purchaser agrees that escrow agent shall have the right to commingle, for investment purposes only, the funds required to be invested under the terms of this Contract with other funds of like nature, provided that escrow agent shall maintain accurate records of the amounts deposited and the proportionate amount of income derived on the amount deposited on an annual basis.

5. ESCROW PROCEEDS: The cost of the funeral service shall be determined at the date of death of the beneficiary. In the event that the escrow account with its accumulation is in excess of the amount required to fulfill the value of the funeral service Contract herein specified, any surplus may be paid to the Purchaser, the estate of the beneficiary, or may offset any additional expenses that may be incurred.

6. PURCHASER’S RIGHT TO CHANGE: Seller agrees that if a different service and/or different merchandise than that set forth in this Contract is desired at the time of the beneficiary’s death, and this Contract has been paid in full, upon direction of the Purchaser, or his/her heirs, assigns, or authorized representative, Seller will apply a sum equal to the then retail purchase price of the services and/or merchandise set forth in this Contract toward the purchase of different services and/or merchandise.

7. ADDITIONAL TRANSPORTATION CHARGE: If the death of a person covered by this Contract occurs beyond a 20 mile radius of Seller’s Funeral Home, Purchaser, or his/her heirs, assigns, or authorized representative will pay in addition to the price set forth in this Contract all costs of any kind occasioned by bringing the remains of said person to Seller’s Funeral Home, unless such transportation was a part of the Contract.

8. ADDITIONAL SERVICES AND MERCHANDISE: In the event that additional services and/or merchandise are desired at the time of need, the retail price in effect at that time shall be charged for those items. The additional expense shall be paid by the purchaser, next of kin, or legal representative of the beneficiary.

9. SUBSTITUTION OF MERCHANDISE: In the event that the exact merchandise set forth in this Contract is unavailable at the time of need and delivery, it is hereby stipulated that the Seller has the right to substitute merchandise similar in style and of equal quality as the merchandise set forth in this Contract.

10. CANCELLATION OF THIS CONTRACT BY THE PURCHASER: After final payment, the Purchaser, upon written notice to the Seller, and to the escrow agent, may cancel this Contract. Upon notice of cancellation, any money in the escrow account, including any accrued interest, less any origination fees and expenses incurred by the Seller for the maintenance of this contract, not to exceed 5% of the escrow account, shall be returned to the Purchaser.

11. DEFAULT: If Purchaser defaults in making payments required under this Contract, or if the Purchaser or the person responsible for making funeral arrangements for a deceased beneficiary fails to have Seller provide services, Seller may retain any origination fee and any costs actually and reasonably incurred by Seller in the performance of the Contract, as liquidated damages provided the sum of the amount retained shall not exceed five percent (5%) of the amount in the escrow account at the time the Purchaser of funeral services defaults in making such payments. The balance of any amount remaining in the escrow account shall be paid to such Purchaser upon request.

12. PARTIAL PAYMENT: If at the time of performance of this Contract Purchaser has not paid the full Contract price, the specified services and/or merchandise will be performed or provided upon payment of an additional amount equal to the difference between the then prevailing price for the merchandise and/or services purchased and the sum of the principal payments and interest earned on the account.

13. RELEASE OF ESCROW ACCOUNT: The escrow agent shall pay to the funeral service establishment upon submission to the agent proof that the services, personal property and merchandise contained herein has been fully performed or delivered.

14. FAILURE TO PERFORM BY SELLER: If for any reason the Seller fails to meet the obligations imposed herein promptly, after a request to do so by an authorized person; the family, the next of kin, or legal representative of the deceased person, having provided for such services, personal property or merchandise on behalf of such deceased person, may receive from the escrow agent the amount of money in the escrow account.

15. REFUND ON IMPOSSIBILITY OF PERFORMANCE: A refund of all monies paid on this contract plus all interest earned or accrued shall be paid to the Purchaser by the escrow agent upon notification by the Seller that he is prevented from performing because of circumstances beyond the Seller’s control.

16. ITEMS NOT PROVIDED AT THE TIME OF NEED: Credit will be given by the Seller for services and/or merchandise which is not provided at the time of need, at the retail price stipulated in this Contract.

17. SELLER’S RIGHT TO SUBCONTRACT: It is agreed that the Seller has the right to hire another funeral service provider to perform services set forth in this Contract, in the event that the Seller is unable to perform because of unforeseen circumstances, such as an out of state death.

18. CHANGE OF ADDRESS OF THE PURCHASER: The Purchaser shall notify the Seller of any change of address.

19. ASSIGNMENT OF CONTRACT: The Purchaser shall notify the Seller in writing of any assignment of this Contract.

20. CASH ADVANCE CHARGES: If the Purchaser has contracted for any cash advance charges, or made provision for Connecticut sales tax, as stated on the STATEMENT OF MERCHANDISE AND SERVICES SELECTED, this paragraph shall apply. The amount paid as a cash advance, or Connecticut sales tax, shall be deposited into the escrow account. At the time of performance, if the amount on deposit in the escrow account, allocable to the cash advance items or Connecticut sales tax, including interest earned or accrued, is less than the current amount required for these items, the Purchaser agrees that the Seller under the contract has the right to charge for the additional amount in addition to the proceeds of the escrow account.

21. INTEGRATION: This Contract contains the entire Contract between the Purchaser and Seller. Purchaser certifies that no oral or written statements, promises, representations or guarantees other than those contained herein have been made. No further communication, representation, understanding or other Contract varying or extending the provisions of this Contract shall be binding upon either the Purchaser or Seller.

I have received a copy of the General Provisions.

Revocable Burial Plot Funeral Contract

THIS REVOCABLE BURIAL PLOT FUNERAL CONTRACT is entered into this day of by and between

a Connecticut business with an address as , Connecticut (“Seller”) and , an individual currently residing at (“Purchaser”).

RECITALS:

1. Seller is engaged in the business of operating a funeral home establishment.

2. Purchaser wishes to purchase and pay for certain burial plot items as provided herein.

AGREEMENTS:

1. Simultaneously with the execution of this Agreement, Purchaser is paying the amount of $ (the “Contract Sales Price”) to Seller to purchase the following burial plot items (check appropriate boxes and indicate amount(s)):

Burial Plot $

Gravesite $

Crypt $

Mausoleum $

Casket $

Urn $

Headstone or Marker $

Outer Burial Container $

Arrangements for opening and closing of gravesite $

TOTAL $

2. The Contract Sales Price will be used for the disposition of the remains of [insert name], currently of [insert current address] (the “Contract Beneficiary”). The social security number of the Contract Beneficiary is . The Contract Beneficiary is the Purchaser or is the of Purchaser.

3. Following the execution of this Agreement by Purchaser and Seller, Seller will deposit the Contract Sales Price with an escrow agent (“Escrow Agent”). The Escrow Agent for this contract will be , of . The telephone number of the Escrow Agent is . The funds held by the Escrow Agent shall be invested in accordance with Connecticut law.

4. Seller agrees to provide the burial plot items specified in Section 1, above, upon request from the Purchaser or the Purchaser’s personal representative, for the Contract Sales Price.

5. This is a revocable contract which may be cancelled by Purchaser or by Purchaser’s personal representative upon written notice to Seller and to the Escrow Agent.

6. Purchaser agrees that the terms and conditions contained on the page entitled “Additional Terms and Conditions” attached hereto shall constitute a part of this Agreement and are incorporated herein by this reference.

7. Purchaser acknowledges that he/she has received a completely filled-in copy of this Agreement, and that he/she has also received or reviewed the Seller’s Price List.

Dated at , Connecticut this day of 20 .

REVOCABLE BURIAL PLOT FUNERAL SERVICE CONTRACT
ADDITIONAL TERMS AND CONDITIONS

1. Contents of Burial Plot Funeral Contract. This Revocable Burial Plot Contract consists of the following: (a) a statement of merchandise and services selected, (b) a statement of additional terms and conditions, and (c) a certificate of ownership.

2. Establishment of Escrow Account. Seller will deposit in escrow with a qualified escrow agent, 100% of each payment received under this contract. All interest, dividends and other income earned on the amounts deposited in the Escrow Account (less any administrative expenses) shall become a part of the account. The Escrow Agent shall be entitled to charge an administrative fee for acting as Escrow Agent. This fee will be deducted from the Escrow Account balance. Seller shall provide the Escrow Agent with the name and address of Purchaser and the name of the Contract Beneficiary, a copy of this contract, including a statement of the merchandise and services selected.

3. Annual Statement of Account. Each party to this contract shall receive an annual report from the Escrow Agent containing information relating to the balance in the Escrow Account.

4. Purchaser’s Default. If prior to final payment of this contract, Purchaser defaults in making any payment required herein, Seller may retain any origination fee and any costs reasonably incurred by Seller in performance of this contract, as liquidated damages, not to exceed 5% of the amount in the Escrow Account. After deducting such charges, the balance of any amounts remaining in the Escrow Account shall be paid to Purchaser upon request.

5. Release of Escrow Account. The Escrow Agent shall pay the funds in the Escrow Account to Seller upon submission to Escrow Agent of a statement indicating that the services, personal property and merchandise contained herein has been fully performed or delivered. If the actual amount of the funds in the Escrow Account at the time of need and delivery exceed the actual cost of the goods and services provided, the excess shall be returned to Purchaser or to Purchaser’s personal representative.

6. Failure to Perform by Seller. If for any reason the Seller fails to meet the obligations imposed herein promptly after a request to do so by an authorized person, the family, next of kin or legal representative of the deceased person, having provided for such services or merchandise on behalf of such deceased person, may receive from the Escrow Agent the amount of money in the Escrow Account.

7. Purchaser May Cancel Contract. This is a revocable contract and Purchaser or Purchaser’s personal representative may cancel this contract at any time before performance by Seller. If this contract is cancelled, the balance of the Escrow Account, less any origination fee and costs reasonably incurred by Seller in performances of this contract, will be returned to Purchaser or to Purchaser’s personal representative.

8. Substitution of Merchandise. In the event that the exact merchandise set forth in this contract is unavailable at the time of need and delivery, it is agreed that Seller will have the right to substitute merchandise similar in style and of equal or better quality as the merchandise set forth in this contract.

9. Purchaser’s Right to Change. Seller agrees that if different services or merchandise are desired than those specified herein, Purchaser, next of kin, heirs or personal representative may direct Seller to apply the proceeds of the Escrow Account toward the purchase of the desired services and merchandise.

10. Additional Services or Merchandise. In the event that additional services and/or merchandise are desired at the time of need, the retail price in effect at that time shall be charged for those items. The additional expense shall be paid by Purchaser, next of kin, or personal representative of the deceased.

11. Items Not Provided At Time of Need. Credit will be given by Seller for services and/or merchandise which is not provided at the time of need, at the retail price stipulated in this contract.

12. Seller’s Right to Subcontract. It is agreed that if Seller is unable to perform at the time and need of delivery because of unforeseen circumstances, Seller shall have the right to hire another funeral service provider to provide the services and merchandise set forth in this contract.

13. Change of Address. Purchaser shall notify Seller and Escrow Agent of any change of address.

14. Assignment of Contract. Seller shall have the right to assign this contract to any successor to Seller’s business. Purchaser may also assign his/her rights under this contract. In the event of any assignment by Purchaser, Purchaser shall provide written notice to Seller.

15. Cash Advance Charges. If the Purchaser has contracted for any services or item(s) to be provided by a third party, this paragraph shall apply. The amount paid as a cash advance shall be deposited into the Escrow Account. At the time of performance, if the amount on deposit in the Escrow Account, allocable to the cash advance items, including interest earned or accrued, is less than the current amount then required for a cash advance item, Purchaser agrees that Seller will have the right to charge for the additional amount in addition to the proceeds of the Escrow Account.

16. Refund on Impossibility of Performance. A refund of all monies paid on this contract plus all income earned or accrued shall be paid to Purchaser or to Purchaser’s legal representative by the Escrow Agent upon notification by Seller that Seller is prevented from performing this Agreement because of circumstances beyond Seller’s control.

NOTE: IF THIS AGREEMENT IS SIGNED AT THE HOME OF THE PURCHASER OR AT SOME PLACE OTHER THAN THE SELLER’S PLACE OF BUSINESS, THEN THE PURCHASER IS ENTITLED TO THE FOLLOWING NOTICE AND HAS THE FOLLOWING RIGHTS UNDER CONNECTICUT LAW:

YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.