Service Selection Form

This form is a services selection form in which you are choosing which services you would like our Funeral Home to perform. By selecting these services you are agreeing that you will have a financial obligation of some amount based on the services selected. You may refer to our website for full descriptions and/or item numbers.

Decedent's Name

Payment Plans are Available

If you want to try to set a Payment Plan up, WHEN YOUR DONE completing these forms please click on payments plans at the top of the home page.

1.

Cremation with Memorial Service Complete Starting @ $2000 (Proceed To Question 2)

Cremation (Proceed To Question 2)

Burial (Sign and Funeral Director will assist you)

2. ($895 Direct Cremation Only) DIRECT PAY Discounts are applied for this price. Insurance and/or 3rd Party billing are not discounted to this price. Normal Completion time without a Rush is 8 to 25 business days.

Does the Decent's weight over 250lbs? If so Additional Charges will be assessed per our GPL

$250 Rush (4 Business Days)

3. Urn: This is the container in which you would like your loved one in after the cremation is complete.

$0.00 Temporary Cardboard (Included)

$25.00 Transportation Urn (Basic Plastic Upgrade)

Other (Specify Item / Package from website) Other (Specify Item / Package from website)

4. Viewing: This section may come with some restrictions. Make your selection and your funeral director will assist you with your exact charges. (ID viewing is NO embalming up to 10 Immediate Family Members Only for 1 hour)

$400 ID Viewing without Autopsy

$495 ID Viewing with Autopsy

$2600 Public Viewing with rental casket and embalming (2hr)

NONE

5. Witness Cremation: This is a service in which we can perform a witness to the cremation where you may watch the body of your loved one in a cremation container of your choice going into the cremation machine at the start of the process. This service is not for everyone and must be scheduled. Up to 10 family members may be present. You will be in a room separate from the body but be able to view this process through a window. Approx 20 min. of time. ( NOT A GUARANTEED SERVICE AND EXTRA FEES FOR AUTOPSY CASES )

Fee for this service $495

6. Mailing Services (you WILL be required to complete the USPS Mailing Form in the forms section)

Mailing through USPS signature receipt ($290.00) The USPS now mandates all Cremated Remains be shipped EXPRESS only and DO NOT offer electronic submittal

Local Pickup ($0.00)

7. Media: These are printed material items: Service Folders

Bookmarks $75 per 100

Prayer Cards $50 per 100

Register Book $35/$45

Scattering Yes or No $125

8. Keepsakes. I am interested in speaking with you more about

Necklace Item

Cylinders Item

Keepsake Urns Item

Fingerprints ($75) JUST THE PRINT (1) DOES NOT INCLUDE NECKLACE

Clipping of hair ($75 Small Clipping) Not Applicable if in body bag

Do you want Funeral Home to get Death Certificates for you? ($75 application fee Applies) You can get them yourself SEE CONFIRMATION PAGE FOR DETAILS
If you purchase a Package other than Direct Cremation OR "proof of POSISTIVE GOOGLE REVIEW" this fee is waived. *

YES

NO

9. Death Certificates: State Charge of $20 and $13 per order (Enter Quantity Needed): MAY TAKE SEVERAL WEEKS TO OBTAIN

9a. Coroner PENDING or DIFFERED Death Certificates $20 per copy

10. Was A Coroner Involved?

Yes (A $75 fee will be added for Coroner Pouch Replacement)

No

11.

Obituary on our Web Site $0.00 Obituary on our Web Site $0.00

12. Does This Person Have A Pacemaker and/or Battery Implanted Device

Yes ($100 fee is required to remove and discard of it)

No

13. Are you going to be working with FEMA for Covid ReImbursement? If YES, you will be charged $695 for our Professional Fees so we may accommodate the amount of work they will require from our firm. This also will include your Necessary Documents to include an explanation letter.

Yes ($695 fee is required)

No

Agreement to services selected, Please Print Your Name:

Date +

I understand that this is just an INTENT to select services. There may be more charges that will be incurred as this form does not address all circumstances. Signature *

clear

ACS will NOT fill 3rd party purchased keepsakes and jewlery due to so many problems from cheaply made products. This includes any and ALL products from Perfect Memorials