A Name You Can Trust.

Transcription

1 Affordable Memorial Care FTC Disclosure / Disclaimer Form The Federal Trade Commission's Funeral Industry Practices Rule requires certain disclosures and prohibits misrepresentations. This Disclosure/Disclaimer Form is a checklist we ask those we serve to read and sign if during the funeral arrangements our firm complied with the following: NAME OF DECEASED OR PREARRANGER: DATE OF DEATH OR PREARRANGEMENT: PLEASE NOTE: THIS FORM DOES NOT REPRESENT A CONTRACT WITH THE FUNERAL HOME ESTABLISHMET. 1. The undersigned received a General Price List effective on January 01, 2018 prior to discussing prices, services, or merchandise. 2. The undersigned received a Casket Price List effective on January 01, 2018 prior to viewing or discussing prices of caskets. 3. The undersigned received an Urn Price List effective on January 01, 2018 prior to viewing or discussing prices of urns. 4. The undersigned received an Outer Burial Container Price List effective January 01, 2018 prior to viewing or discussing prices of outer burial containers. 5. The undersigned were informed that the law does not require a casket for direct cremation. 6. The undersigned were informed that the law does not require the purchase of an outer burial container except in certain cases where the cemetery may require it. 7. The funeral home made no representations to the undersigned that embalming or the use of any merchandise available from the funeral home would delay the decomposition of the remains for a long time or indefinite time. 8. The undersigned understands that the funeral home has disclaimed all warranties with regard to caskets, urns, outer burial containers, and other merchandise sold by the funeral home. 9. The undersigned understands that the only warranties, expressed or implied, granted in connection with the goods sold by the funeral home are the express written warranties, if any, which are extended by the manufacturers of the goods. No other warranties, including the implied warranties of merchantability or fitness for a particular purpose are extended by the funeral home. 10. The undersigned attests that they understand that any selections they may make in regards to services or merchandise are within accordance to their choice and their budget. _ PRINTED NAME: SIGNATURE: DATE: A Name You Can Trust.

2 GENERAL PRICE LIST The goods and services shown in this price list are those we can provide to our customers. You may choose only those items you desire. (However, any funeral arrangements you select will include a charge for our basic services and overhead.) If legal or other requirements mean that you must buy any items that you did not specifically request, then we will explain the reason to you in writing on the contract. These prices are effective as of January 01, 2018, and are subject to change without notice. For Your Convenience We understand that financial hardship occurs in families. With that in mind, we ask that you choose arrangements that you feel that you can afford and feel comfortable with. If you have questions or concerns, please let us know. Our methods of payment include: Prepaid Funeral Policies, Check, Cash, Insurance Assignment (Policy over twoyears old, subject to validation), and Credit / Debit-Card, (MasterCard, Visa, and Discover, ONLY); we can also help you with County Assistance. By Engaging our Services You are Hereby Authorizing Us to do the Following*: Issue public notification of your (if prearranging services for yourself) / your loved one s passing. Prepare and file all necessary forms required to carry out our duties and/or in order to fulfill your wishes. o Collect all necessary information required to prepare and file all aforementioned forms. Contact you and/or any other persons involved in the services in order to acquire all aforementioned information. Contact and arrange with all persons involved in the services in order to schedule and set-up services. Forward / Pay any funds granted to us to the appropriate parties in order to arrange the services and/or order the merchandise you have selected and/or require. o For those Prearranging, this includes forwarding / paying any funds granted to us to the National Guardian Life Insurance Company where said funds will be held in an prepaid / preneed funeral insurance policy. Also, for those prearranging, this includes authorizing us to collect all funds following from the National Guardian Life prepaid / preneed funeral insurance policy, at the time of the insured s passing. Correct / update any form, merchandise, and/or service, if necessary.* *(If any form, merchandise, and/or service, needs to be corrected / updated, and you provided and/or approved the form, merchandise, and/or service, in its incorrect or outdated state, then you authorize us to collect all costs associated with correcting / updated the form, merchandise, and/or service, in addition to a $50.00 correction / updating fee, from you. {The correction / updating fee will only be assessed in the event that the correction / update has third-party, cash-advance, and/or out-of-pocket costs associated with it.}) Change / replace any form, merchandise, and/or service, at your request.* *(If you request any form, merchandise, and/or service, to be changed / replaced, and you provided and/or approved the form, merchandise, and/or service, in its older or original state, then you authorize us to collect all costs associated with changing / replacing the form, merchandise, and/or service, in addition to a $50.00 change / replacement fee, from you. {The change / replacement fee will only be assessed in the event that the change / replacement has third-party, cash-advance, and/or out-of-pocket costs associated with it.}) *(Please understand, while we do ask for your signature, neither your signature nor your express permission are not required in order for us to carry out our duties. Any actions required in order to fulfil our duties will be undertaken with the implicit understanding in place that you have chosen to engage our services with full awareness of this fact; thank you very much for choosing to consider our services for assisting you in your time of need.)

3 GENERAL PRICE LIST These prices are effective as of January 01, 2018 and are subject to change without notice. You may choose only the items you desire. If you are charged for items you did not specifically request, we will explain the reason for the charges on the written memorandum. Please note that there may be charges for items such as cemetery fees, flowers, and newspaper notices. The goods and services shown below are those we can provide to our customers. You may choose only the items you desire. However, any funeral arrangements you select will include a charge for our basic services and overhead. If legal or other requirements mean you must buy any items you did not specifically ask for, we will explain in writing on the statement we provide describing the funeral goods and services you selected. PROFESSIONAL SERVICES OF FUNERAL HOME AND STAFF: A. SERVICES SELECTED 1. PROFESSIONAL SERVICES a) SERVICES OF FUNERAL DIRECTOR AND STAFF $650.00** Our services include: conducting the arrangement conference, planning any services, consulting with family and clergy, preparing and filing of necessary notices, obtaining necessary authorizations and permits, coordinating with the cemetery, crematory, or other third parties. In addition, this fee includes a proportionate share of our basic overhead cost. This fee for our basic services and overhead will be added to (or already part of) the total cost of the arrangements you select. This fee is already considered as included in our charges for cremation and burial packages as well as for forwarding or receiving remains.** (Non-declinable Charge). b) EMBALMING: $ Embalming is not necessarily required by law, in every case. Embalming may be necessary, however, under certain circumstances, and/or if you select certain arrangements, such as a viewing, visitation, or wake. If you do not want embalming, you may have the right to choose an arrangement that does not require you to pay for it, such as direct cremation. c) OTHER PREPARATION: i. Disinfecting, dressing, casketing, and/or cosmetizing of deceased. $ ii. Preparation of an unembalmed body for a brief family viewing during arrangement conference. $ iii. Special care for autopsy or trauma victims $ iv. Restoration fee ($ per hour, after 3 hours) $ v. Removal of Pace-Maker $200.00

4 2. FACILITIES: a) Use of facilities for sheltering of remains (per day charge) b) Use of equipment & staff for the viewing and visitation (per day) c) Refrigeration of remains (per day charge) d) Use of equipment & staff for memorial service (no body present) e) Funeral at other facility or other location with staff services. f) Rosary/Prayer Service/Wake/Vigil with staff services $ $ $90.00 $ $ $ AUTOMOTIVE EQUIPMENT a) Transfer of deceased from place of death to funeral home (within 30-mile radius). Additional distance will be charged at $3.50 per mile. $ b) First-Call Vehicle use, within 30-mile radius. Additional distance will be charged at $2.00 per mile. $ c) Lead Car $ d) Flowr Car $ e) Use of Other Automotive Equipment $50.00 B. MERCHANDISE SELECTED 1. CASKETS: $ $13, A complete price list will be provided at the funeral home. 2. ALTERNATIVE CONTAINERS: $ $ A complete price list will be provided at the funeral home. 3. URNS: $ $3, A complete price list will be provided at the funeral home. 4. OUTER BURIAL CONTAINERS: $1, $15, A complete price list will be provided at the funeral home.

5 5. SUNDRY ITEMS a. Acknowledgment Cards (25 per box) $15.00 b. Memorial Book $50.00 c. Memorial Folders with photo or image of your choosing (per 100) $ d. Temporary Markers $30.00 e. Food Record Book/Pallbearer Cards $5.00 f. Bookmarkers $8.00 (Apiece) g. Box Set (Matching Set of Book, Folders, Cards, and Accessories) $ C. PACKAGE CHARGES SPECIAL SERVICES: Arranging for a Cemetery within the United States (already included in funeral and cremation packages): $ Cremation witnessing, observation, and family participation (per hour) $ Ceremonial bathing and use of preparation room: Overnight vigil: $ Transfer to a Foreign Country: $ Shipping of Cremains via USPS registered mail, including supplies: $ Fee Assessed by USPS, (based upon combined weight of cremains and urn and the delivery priority requested) FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME: $1, This charge includes removal of remains, minimum services of staff, authorizations, embalming, use of preparation room and local transportation (This charge does not include shipping charges or cost of a casket) RECEIVING REMAINS FROM ANOTHER FUNERAL HOME: $1, This charge includes minimum services of staff, transportation of remains to local cemetery or crematory. This charge does not include services of staff for funeral service or use of facilities for any visitation, rites, or ceremonies.

6 CREMATIONS: $ Our charges for all cremation packages include: services of funeral director and staff, removal of decedent from place of death, (within 30-mile radius, additional distance will be charged at $3.50 per mile), refrigeration of remains, (offsite, only if necessary), transportation to crematory, and basic services of staff; urn is not included, crematory fee is not included. Crematory Fee $ BURIALS: $2, Our charges for all burial packages include: services of funeral director and staff, embalming, other preparation of decedent, 1 day of viewing/visitation/wake, funeral services, the removal of decedent from place of passing, (within 30-mile radius, additional distance will be charged at $3.50 per mile), use of first-call vehicle, (within 30- mile radius, additional distance will be charged at $2.00 per mile), 1 memorial book, 100 memorial folders, and 1 box of 25 Acknowledgment Cards; casket is not included. (Add a (Sentry, Basic Metal) casket for an additional $600.00) D. CASH ADVANCES Death Certificates $20.00 for the first certified copy + $13.00 for each additional (Per Order / Batch){As Priced by the County/State} Clergy and Music Honorariums As Determined by Family SPECIAL NOTES: 6.9% STATE / COUNTY SALES TAX WILL BE CHARGED ON ALL MERCHANDISE INSURANCE PROCESSING / CONVENIENCE FEE: 7% of the total cost of the funeral will be charged if the family chooses to pay by assigning insurance.

7 CASKET PRICE LIST Steel Logan 18 Gauge Steel (Protective) Silver Rose Finish Pink Crepe Interior $3, Ridgeway Lightweight 20 Gauge (Protective) Spruce Blue Shaded Platinum Finish with Blue Crepe Interior $2, Misty Pink Lightweight 20 Gauge Steel (Protective) Pastel Pink Shaded White Finish with Pink Crepe Interior $2, With Honor Lightweight 20 Gauge Steel (Protective) Platinum Shaded Dark Gunmetal Finish with Ivory Crepe Interior $2, Essex 20 Gauge Steel (Protective) Ebony with Mirror Side Finish and White Crepe Interior $2, Sutton 20 Gauge Steel (Non-Protective) Silver Shaded Dark Gunmetal Finish with White Crepe Interior $2, Sentry Lightweight 20 Gauge Steel (Non-Protective) (Comes in Seven Color-Combination Varieties) $1, Silver Finish with White Crepe Interior Monarch Blue Finish with Blue Crepe Interior White Finish with White Crepe Interior White Finish with Pink Crepe Interior Orchard Finish with Pink Crepe Interior Copper Finish with Rosetan Crepe Interior Venetian Bronze Finish with Rosetan Crepe Interior Wood Sandhurst II Poplar Veneer (Non-Protective) Satin Light Sandy Birch Finish with Rosetan Crepe Interior $4, Whitmire II Poplar Veneer (Non-Protective) Satin Dark Walnut Finish with Rosetan Crepe Interior $3, Meredith Poplar Veneer (Non-Protective) Gloss Dark Walnut Finish with Rosetan Crepe Interior $2, Endicott Poplar Veneer (Non-Protective) Gloss Dark Cambridge Finish with Rosetan Crepe Interior $2, Copper Lincoln 32 Ounce Copper (Protective) (Comes in Three Color-Combination Varieties) $7, Brushed Natural / Lilac Finish with Ice Pink Velvet Interior Brushed Natural / Heritage Bronze Finish with Almond Velvet Interior Silver Cloud Finish with Light Blue Velvet Interior Alternative Containers Cremation Casket (Cloth-Covered Wood) (Non-Protective) $ Use of the Ceremonial Casket for Viewing(s) and/or Service(s) (Includes a Crematable Insert) $ Combination Shipping Container $ Air Tray $ Cremation Container (Cardboard) $ Body Pouch $ _ WARRANTIES Affordable Memorial Care makes no representation or warranties regarding the caskets listed above. The only warranties, express or implied, granted in connection with caskets sold are the express written warranties, if any, extended by the manufacturers of the caskets. Affordable Memorial Care hereby expressly disclaims all warranties, expressed or implied, relating to the caskets, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose.

8 URN PRICE LIST Semi-Precious Wood $ Copper Urn $ Bronze Urn $ Military Hardwood Urn $ Scattering Urn $ Urns are crafted from various materials in a wide range of prices. We have selections in copper, sheet bronze, hardwood, and marble. Many are in stock; most are available with two-day delivery. Our professional staff will assist you with any questions you may have concerning cremation urn options. Prices are effective as of January 01, 2018, and are subject to change without notice. WARRANTIES Affordable Memorial Care makes no representation or warranties regarding the urns listed above. The only warranties, express or implied, granted in connection with urns sold are the express written warranties, if any, extended by the manufacturers of the urns. Affordable Memorial Care, hereby expressly disclaims all warranties, expressed or implied, relating to the urns, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose.

9 OUTER BURIAL CONTAINER PRICE LIST Veteran Triune $3, Cameo Rose Triune $3, Stainless Steel Triune $3, Poly-Guard Vault $1, Concrete Liner $ These prices are effective as of January 01, 2018, but are subject to change without notice. WARRANTIES Affordable Memorial Care makes no representation or warranties regarding the outer burial containers listed above. The only warranties, express or implied, granted in connection with outer burial containers sold are the express written warranties, if any, extended by the manufacturers of the outer burial containers. Affordable Memorial Care, hereby expressly disclaims all warranties, expressed or implied, relating to the outer burial containers, including, but not limited to, the implied warranties or merchantability and fitness for a particular purpose. In most areas of the country, state or local law does not require that you buy a container to surround the casket in the grave. However, many cemeteries ask that you have such a container so that the grave will not sink in. Either a burial vault or grave liner will satisfy these requirements.