1. ______

Expenses are to be paid in full by cash, check, MasterCard or Visa within 30 days from the day of the service or disposition. In all cases where the total payment has not been received in 30 days, a Late Payment Charge of 1.5% per month (18% per year) shall be added beginning on the 31st day. There will be no exceptions to this policy.

2. ______

A discount of $________ shall be offered if expenses are paid by, or no later than, _______________. If the not, option #1 above will take effect.

3. ______

Life insurance proceeds with assignment will be accepted once coverage has been verified through the insurance carrier.  The funeral home will assist with the necessary documents and proceeds will be paid to the funeral home. If coverage cannot be verified during the funeral arrangement conference, payment of expenses must be secured with a credit card until verification is made.

4.______

Pre-Funded Funeral Account:  Depending on the specific pre-arrangements, a balance may be owed. Please select an above payment option.

5. ______

More Than One Purchaser: In the case where more than one family member will share in payment of the total funeral bill, we ask that the family designate one family member to be responsible to the funeral home for the total funeral bill. The individual family members may then reimburse the designated family responsible party. If expenses are not paid in full within 30 days, option #1 will take effect.

RETURNED CHECK FEE - You will be assessed a returned check fee of $25.00 each time a check is returned by our bank for insufficient funds.

ESTATE PAYMENTS: Past experience has shown estates can take two months or longer to be in a position to pay the account. It is the responsibility of the purchaser(s) signing the statement of goods and funeral services to pay the expenses in full with one of the above options. The funeral home will provide all necessary documents for the responsible party to be reimbursed from  estate.

(1) Signature of Purchaser ______________________________________

Print Name ____________________________________________

Social Security No.______________________________________________

Telephone No._________________________________________

Address  ____________________________________________________________________________________________________________________________

(2) Signature of Purchaser ______________________________________

Print Name ____________________________________________

Social Security No.______________________________________________

Telephone No. _________________________________________

Address _____________________________________________________________________________________________________________________________