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TEMPLE PREVIEW

HOUSTON PREVIEW

DALLAS PREVIEW

Step 1 of 2

Your Name

First Last

Your Email

Your Phone #

Name of Deceased

Age

Date of Death

Time of Death

Location of the Deceased

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If another person has an equal priority right to authorize cremation, the authorizing agent has made all reasonable efforts but failed to contact that person and believes the person would not object to the cremation and agrees to indemnify and hold harmless the funeral establishment and the crematory establishment for any liability arising from performing the cremation without the person's authorization .

Initial

List any valuables to include jewelry, personal effects, etc. that are being delivered to the crematory with the deceased and instructions for handling of said valuables.

THE DECEASED DOES ____ , DOES NOT ___ CONTAIN ANY TYPE OF IMPLANTED MECHANICAL OR RADIOACTIVE DEVICE. (please select one)

DOES

DOES NOT

SIGNATURE OF PERSON(S) AUTHORIZING CREMATION AND DISPOSITION

I/We warrant that all representations and statements mad herein are true and correct and that I have read and understand the provisions contained in this documents.

Signature

Relationship

Date

Acknowledgement of Waiver of Right of Identification(Required)

I, the undersigned Authorizing Agent do hereby waive my right of identification of the above named deceased person. I decline to view the remains of the deceased and acknowledge that the Funeral Director and/or Funeral Establishment will rely on the institution where death occurred for identification of said remains.

Signature of Authorizing Agent

Printed Name of Authorizing Agent & Relationship

Date of Acknowledgement

Cremation Price

Price:

Mail or Scattered?

Mail - ($150) Please expect 20-30 days for your loved ones remains and death certificates to arrive.

Please Scatter the Ashes

Land or Offshore?

Land - (Free) Ashes are scattered on state-approved memorial gardens

Offshore - ($500) Includes a biodegradable urn and will be scattered off the Texas coast.

Mail Ashes to (if different from the previous address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

Credit Card