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.
1.
2. ($495 Direct Cremation Only) DIRECT PAY Discounts are applied for this price. Insurance and/or 3rd Party billing are not discounted to this price.
 
3. Urn: This is the container in which you would like your loved one in after the cremation is complete.
 
4. Viewing: This section may come with some restrictions. Make your selection and your funeral director will assist you with your exact charges.
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.
6. Mailing Services
7. Media: These are printed material items: Service Folders
8. Keepsakes
10. Was A Coroner Involved?
11.
 
12. Does This Person Have A Pacemaker and/or Battery Implanted Device
calendar
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
Powered byFormsiteReport abuse