Please fill out the decedents name and the purchasers name and address. Then scroll down to the bottom and sign the cremation contract, then scroll down to the bottom and sign WITH YOUR MOUSE OR FINGER, then hit “Submit”.
    We will fill it out with the choices that you have made and send it back to you. We will then call you to collect payment.
    Going Home Cremation Services, Inc.
    1120 Pinellas Bayway, Tierre Verde, Fla. 33715 727-800-6819 941-320-1179 Fax 727-934-1529
    STATEMENT OF GOODS AND SERVICES
    Name of Deceased  
    D.O.D.  
    DOB. 
    Purchase Name(s) 
    Telephone # 
    Purchaser Relationship to deceased 
    2nd Telephone # 
    Address 
    City 
    state 
    Zip 
    AGREEMENT FOR SALE AND PURCHASE
    1.     This agreement is made & entered into by & between Going Home Cremation Services, Inc. hereinafter referred to as the SELLER,& the Purchaser(s) named above. The Direct Disposer (Seller), as designated preference of Purchaser, obligates itself to provide the Cremation service. This agreement is subject to acceptance by the SELLER.
    2.     The Purchaser agrees to purchase, at the price(s) indicated below, service and/or merchandise which conform to the general description or are of equivalent quality to those listed below, & SELLER agrees to furnish such services and/or merchandise upon payment of the Purchaser of the price set forth in the agreement. The parties acknowledge that this agreement does not call for the sale of any specific brand or make of merchandise. Purchaser received a copy of the General Price List (GPL)
    3.     Charges are only for those items that you selected or are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below. FTC DISCLOSURES. Embalming in not required. We refrigerate in lieu of embalming. Cremation requires an Alternative container. Our charge for direct cremation includes services of director and staff; portion of overhead costs; transport to crematory; removal and refrigeration; alternative container.* We charge extra for items asterisked below. Cremation can take 7-10 business days.
    CHARGES FOR MERCHANDISE SELECTED
    URN(S)   $ 
        Type 
    Keepsake   $ 
        Type 
    Engraving   $ 
        Type 
    Other items   $ 
        Type 
    Alternative container   $ 
    Total Merchandise selected   $ 
    CASH ADVANCES
    *Certified Copies of Death Certificate
     copies @   $ 
    *Short (without cause of death)   $ 
    *Long (with cause of death)   $ 
    Scattering of Ashes   $ 
    Delivery of Ashes   $ 
    *Medical Examiner fee   $ 
    Storage of deceased or cremains   $ 
    Rush fee   $ 
    Insurance Assignment Fee   $ 
    Total Cash Advances   $ 
    DIRECT CREMATION SERVICES.
    Cremation with fiberboard container   $ 
    Fingerprinting/hairclipping   $ 
    TOTAL OF ALL CHARGES   $ 
    Pacemaker removal    $ 
    Transport & refrigeration   $  incl 
    Home Removal w/2 people are needed   $ 
    TOTAL OF ALL CHARGES   $ 
    Home Removal/Addtl mileage   $ 
    Shipment of Ashes   $ 
    *Admin.fee for paperwork   $ 
    *Courier to obtain D/Cs   $ 
    Deposit Check  Credit Card   $ 
    BALANCE DUE   $ 
    PIF Date   $ 
    Personal protection/contagious disease   $ 
    Over 220 lbs.   $ 
    Total Services Selected   $ 
    $
    I/We warrant that all representations & statements made herein are true & correct, & that I/we have read and understand the provisions contained in this document. I/We have the right to authorize the cremation of the deceased, and are not aware of a person who has a superior priority right or are not aware of a person of equal priority who disagrees with authorizing the cremation.
    By signing this form we hold harmless the Crematory, or any other Florida Crematory used, the D.D., & their agents or assigns from any and all claims related to this cremation service, identification of deceased, said shipment, storage, delivery, or care of cremains for any length of time. This release extends to any and all employees of the crematory or of the Direct Disposer and any or all of their officers, family and or assigns. WE HOLD HARMLESS Going Home Cremation or affiliate, officers or assigns liability regarding above named cremation and cremains in any manner. I authorize this Direct Disposer establishment to perform the services, and to furnish the goods as specified on this Statement
    I acknowledge that I have received the general price list and urn price list including the outer burial container prices.
    *We upcharge for these items.WE HAVE BEEN GIVEN A GENERAL PRICE LIST AND OUR VERBAL AUTHORIZATION OVER THE PHONE SERVES AS SIGNATURE FOR THIS SALE.
    The Parties hereto have executed this agreement set forth to their respective names. The date of this agreement shall be the date when the last one of the SELLER & PURCHASER has signed this Agreement. This agreement is not binding until accepted by the SELLERS & Purchaser acknowledges receipt of an exact copy of agreement. Purchaser acknowledges that this agreement was complete as to all essential provisions before it was signed.
    Dated this 
     day of , 20
    Direct Disposer 
    Purchaser 
    The SELLER hereby accepts and agrees to be a party to the foregoing Agreement.
    Going Home Cremation Services (24 Hours) 727-800-6819 Fax 727-934-1529