HUCKLEBERRY CREEK Future Pre-Plan Form

FAMILY CONTACT INFO

Name of Future Client*:

Name of Person Completing Form*:

Best Contact Phone Number*:

Email*:

 

 

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GENERAL PRICE LIST

Acknowledgment*:

 I have reviewed the General Price List online

$995 FUTURE PRE-PLAN CREMATION PACKAGE INCLUDES:

• Basic services of funeral director and staff
• Pickup and transport of the decedent (<300lbs) from another funeral home, hospital, coroner/medical examiner’s office (in King, Kitsap, Lewis, Mason, Pierce, Thurston, Grays Harbor, Jefferson, and Pacific counties
• Refrigeration and sheltering the decedent (10days)
• Cardboard cremation tray
• Cremation process
• Order & obtain death certificates (cost of death certificates not included)
• Black plastic utility urn.
• Complimentary Shipping of Remains in Washington or Pickup at our office.

Does not include any government fees or any other other product or service not listed here.

FUTURE PRE-PLAN CREMATION PACKAGE

Select Cremation Package*:

Standard Cremation ($995.00)

Select Decedent Weight*:

Less than 300lbs ($0.00) 300-349lbs ($350.00) 350-399 ($400.00) 400-499lbs ($650.00) 500-599 ($1,000.00)

Huckleberry Creek Cremation does not offer identification or formal viewings, nor does it offer any type of witness cremation.

VIEWING & WITNESS ACKNOWLEDGEMENT

Viewing Acknowledgement*:

I acknowledge that HCC does not offer identification or formal viewings, nor does it offer any type of witness cremation. ($0.00)

Direct cremation normally takes 1-2 weeks. Would you like to expedite the process? Rush Cremation takes place 1-2 days after the permit is obtained and authorizations are secured. Priority Rush will be Next Day after obtaining the permit.

EXPEDITE "RUSH" CREMATION

Select Rush Cremation*:

No RUSH needed ($0.00) Add RUSH Cremation ($195.00) Add PRIORITY RUSH ($295.00)

ADDITIONAL SELECTIONS

Take Fingerprint for Jewelry*:

No Fingerprinting ($0.00) Add Fingerprinting ($25.00)

Take Locket of Hair*:

No Locket ($0.00) Add Take Locket of Hair ($25.00)

What would you like us to do with the Cremated Remains when they are ready to be returned to the family? If Shipping or Delivery, please provide the address.

RETURN THE CREMATED REMAINS

Instructions for returning the cremated remains*:

Hold for Pick-up in Tumwater ($0.00) Mail Plastic Urn (in WA) ($0.00) Unattended Water Scattering Unspecified ($0.00) Mail Plastic Urn in US ($195.00) Mail Non-Plastic/Other Urn in US ($275.00) Hand-Delivery to Home or Office (Lewis, Grays Harbor, Pierce, Thurston, Mason) ($100.00) Hand-Delivery to Home or Office (King, Jefferson, Kitsap, Pacific) ($200.00)

Name & Address for Shipping Ashes:

Many families need one or more official certified copies of the death certificate to take care of certain estate, probate, or other business following a death. Certified Death Certificates are ordered and obtained from the local health department. You can have our firm order and obtain official certified copies of the death certificate from the health department for you to pickup at our office or for mailing. You may also order and obtain them directly.

DEATH CERTIFICATES

How many Death Certificates?*:

No Death Certificates ($0.00) 1 Death Certificate ($25.00) 2 Death Certificates ($50.00) 3 Death Certificates ($75.00) 4 Death Certificates ($100.00) 5 Death Certificates ($125.00) 10 Death Certificates ($250.00)

Instructions for returning Death Certificates*:

No DCs Ordered ($0.00) Hold DCs for Pick-Up ($0.00) Hand Deliver DCs with Urn ($0.00) Mail DCs No Tracking ($0.00) Mail DCs with Tracking ($18.00)

Name & Address for Mailing DCs:

OTHER GOVERNMENT ITEMS

Required WA State Fee*:

 WA State Cremation Fee ($10.80)

Anticipated County of Death Permit Fee*:

Thurston County Permit Fee ($0.00) Mason County Permit Fee ($0.00) Lewis County Permit Fee ($0.00) Grays Harbor Permit Fee ($0.00) Kitsap Permit Fee ($0.00) Pacific County Permit Fee ($0.00) Jefferson County Permit Fee ($0.00) Pierce County Permit Fee ($15.00) King County Permit Fee ($100.00) Clark County Permit Fee ($100.00) Snohomish County Permit Fee ($15.00)

VETERAN OPTIONS

Complete Flag App & Retrieve US Flag*:

Not a Veteran Do not want a Flag Retrieve Flag at Post Office

Select Flag Case:

No Flag Case ($0.00) Add Flag Case ($150.00)

Schedule National Cemetery:

No National Cemetery ($0.00) Add National Cemetery Scheduling ($295.00)

Upload Discharge Paperwork (DD214):

HOW DID YOU HEAR ABOUT US?

Please select how your heard about our firm*:

Nisqually Valley News ($0.00) ValPak ($0.00) The Chronicle ($0.00) The Olympian ($0.00) The Daily World ($0.00) Referred ($0.00) Direct Mail ($0.00) Internet Search ($0.00) Other ($0.00)

*NOTE: If your payment preference is monthly payments, please complete this form but don't make the full single payment with your form submission. Instead please submit the form as a quote and our team will contact you to take your first payment by phone and get you set-up with a monthly payment plan. If you plan to make payment in full, then you can submit the form with the total package payment.

*All pre-payments are required by law to placed into a third party account. We use Purple Cross and Global Atlantic for this purpose.

PREFERRED PAYMENT

Choose Pay in Full or Monthly Payment *:

Pay in Full ($0.00) Monthly Payment ($0.00) Undecided ($0.00)

Third-Party Acknowledgement*:

I understand that my prepayment will be managed by a third party who will contact me to finalize the account set-up