Contract

Cremation Society of Orange Coast 333 City Boulevard West Suite 1700 Orange, California 92868 1 (800) 678-0669 License # FD 1704	Service Agreement Statement of Funeral Goods and Services Selected
Services For ____________________________________________________ Date ___________________
Charge for Services Basic Service Funeral Director/Staff .............................. Use of Facilities Equipment and Staff For: Funeral/Memorial at Church or in Chapel ................. Graveside Service ......................................................... Viewing ........................................................................... Weekend, Holiday or evening service........................ Other preparation of the body Embalming........................................................................ Other preparation of the deceased............................... Special care for autopsied remains............................... Refrigeration of remains................................................. Transfer of remains to funeral home ............................... Additional charge for home removal .......................... Additional mileage ...................................................... Funeral coach.................................................................... Long distance transportation.......................................... Disposition of cremated remains:................................... Personal delivery (30 mail radius)............................... Shipping (U.S. Mail)..................................................... Burial at sea.................................................................... ____________________________........................ Total Care Services: Per G.P.L. Dated May 1, 2001 Direct cremation .......................................................... Rush cremation .......................................................... Direct cremation with memorial service .................. Cremation proceeded by public viewing ................. Cremation proceeded by............................................. Graveside/Niche side............................................ Witness cremation .................................................... Decedents in excess of 300lbs ($250 for each additional 100lbs.)........................................... A. Total charge for Services _____________		Charge for Merchandise Urn _____________________........................... Memorial Folders.................................................... Register Book.......................................................... Casket ___________________ ....................... _________________________......................... Sales Tax................................................................... B. Total Charge for Merchandise ___________ Monies Advanced on Families Behalf State Disposition Permit......................................... _____Certified Death Certificates........................ [ ] Clergy Gratuity................................................. [ ] Paid Newspaper Notice.................................. [ ] Musicians......................................................... [ ] Cemetery........................................................... [ ] Coroner Fees.................................................... [ ] State Regulatory Fee...................................... [ ] Floral Services................................................. [ ] ______________________ ...................... C. Total Monies Advanced
		SUMMARY OF CHARGES Total Charges (A, B, C)........................................... Less Payment........................................................... Less __________________ .............................. Balance Due ____________________
PAYMENT TERMS: The below signed purchaser or purchasers either jointly or severally agrees to pay and guarantee payment of the balance due. This guarantee also applies to any additional charges for items ordered by the undersigned, together with any applicable finance charges and all costs of collection including reasonable attorney fees. Acknowledgments: The undersigned hereby acknowledges that he/she has represented himself/herself as having the legal right to make arrangements for the disposition of the deceased and has authorized this firm to take possession of the remains of the deceased and has given permission for the body to be embalmed if a charge has been made for embalming. Disclosures: Charges are only for those items that you selected or that are required. If we are required by law or by a crematory to use any items, we will explain the reasons in writing . If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below: I/We accept and approve the above and acknowledge receipt of a copy of this agreement. Signature _________________________________ Address ________________________________________ Accepted for Cremation Society of Orange Coast by ________________________________________________ FOR MORE INFORMATION ON FUNERAL, CEMETERY & CREMATION MATTERS, CONTACT: DEPARTMENT OF CONSUMER AFFAIRS, CEMETERY AND FUNERAL BUREAU 1625 North Market St. Suite S-208 Sacramento, CA 95834 (916) 574-7870 General Fax (916) 574-8620