Statement Of Funeral Goods And Services Form PDF Details

When planning a funeral for a loved one, there can be a lot of paperwork to review and decisions to make. One document you may see is the Statement of Funeral Goods and Services Form (SFGSSF). This form should provide an itemized list of all goods and services that are being provided in connection with the chosen funeral arrangements. The SFGDSF outlines the costs associated with these items so it's important to understand what it means and how it works before you sign off on anything. In this blog post, we'll take an in-depth look at exactly what is involved in the Statement of Funeral Goods and Services Form -- including what information needs to be included, how much detail is necessary, and why having this type of document can be helpful when making your final funeral selections.

QuestionAnswer
Form NameStatement Of Funeral Goods And Services Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesstatement of funeral goods and services form, statement of funeral goods and services, statement funeral goods, funeral agreement form

Form Preview Example

PART ONE OF -TWO PARTS

4128 Westroads Drive, Suite 203

561-640-9009

Agreement No.

West Palm Beach, FL 33407

Fax: 561-640-4411

 

www.edgleycremationservices.com

STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED/PURCHASE AGREEMENT

Date of Death

 

 

 

 

MO

DD

YR

 

 

Name of Deceased

 

 

 

 

Deceased's Last Address

 

 

 

 

 

 

CITY

STATE

ZIP CODE

Charge to (Buyer) Name

 

Phone No. (

)

 

Buyer's Home Address

 

 

 

 

 

 

CITY

STATE

ZIP CODE

Co-Buyer's Nome

 

Phone No. (

)

 

Co-Buyer's Address

 

 

 

 

 

 

CITY

STATE

ZIP CODE

In this Agreement the words you and your refer to the Buyer and Co-Buyer, if any, signing this Agreement. The words we, us and our refer to the Funeral Provider or Seller whose name and address appear above. For good and valuable consideration, which each party acknowledges receiving, you agree to buy the goods and services described below. You authorize us to prepare and care for the body of the decedent named in this Agreement and to conduct the funeral and services and incur the charges listed in said Agreement. We have the right to called the total amounts due under this Agreement from any person who signs this Agreement as Buyer or Co-Buyer.

Charges are only for those items that you selected or that 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. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below.

SECTION I: SERVICES AND MERCHANDISE

 

MERCHANDISE

FUNERAL DIRECTOR AND STAFF SERVICES

 

Casket/Cremation Casket

Professional Service Fee

 

Item No.

CARE OF PREPARATION OF REMAINS

 

Alternative container

Refrigeration

 

Outside enclosure

Other preparation

$ -

Item No.

TRANSPORTATION

 

Urns and vases

Transferring remains to crematory

 

Item No.

Additional Transportation:

 

TOTAL SECTION I

 

 

 

SECTION II: CHARGES TO BE INCURRED BY US ON YOUR BEHALF

OTHER GOODS AND SERVICES

 

(Certain charges may be estimated - "e" means estimated)

1.

Prayer cards

 

Cemetery

2.

Acknowledgement cards

 

Crematory

3.

Register Book

 

Flowers

A.

Memorial Package

 

Obituary Notices

5.

Scattering at Sea

 

Death Certificates

6.

Obituary Notices

 

Vault Installation

7.

Forwarding of Cremains

 

Clergy/Religious Facility

8.

Expediton of Death Certificate

 

Outside Funeral Director's Expenses

9.

Flowers

 

Medical Examiner's Fee

10.Shipping Container

11. Cemetery

12.Crematory

$

TOTAL SECTION II

TOTAL AMOUNT DUE

PART TWO OF TWO PARTS

Name of Deceased

Agreement No.

STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED/PURCHASE AGREEMENT

TOTAL CHARGES

 

Less cash received

 

Less assignment of,receivable from third party lender

($

Less assignment of

($

Unpaid balance due by:

 

PAYMENT TERMS: You understand that no extension of credit by us, subject to federal or state credit disclosure, installment sales, or other consumer credit statutes, is contemplated by this Agreement. You have no right to defer payment of any amount due under this Agreement. You agree that you are personally liable for payment of the applicable balance due shown on the Statement of Funeral Goods and Services Selected by the date indicated on the Statement. Such payment will be made to us at the address set forth in this Agreement. If you have not paid the principal balance in full within seven days after the date indicated, a one-time default charge of 10% of the unpaid portion of the principal balance will be imposed or the maximum amount allowed by law, if less.

Where the full amount due will not be paid prior to the performing of the services called for by this Agreement, you authorize us to inquire into your credit history.

IDENTIFICATION AND DESCRIPTION OF MANDATORY ITEMS AND EXPLANATION OF EMBALMING CHARGE: We have identified and described below any legal, cemetery or crematory requirements which compel the purchase of any items listed in Part One and we have explained why we charge for embalming. You acknowledge and agree that embalming andtor preparation of the remains may be performed at the facility of the above-referenced funeral home or at another facility that is duly licensed and equipped to provide such services.

You confirm that you have examined the service and merchandise items listed in Part One and found them to be correct and according to the arrangements selected and that prior to signing this Statement, you reviewed and approved a completed copy of this Statement. You also confirm that you have been informed of your right to select only such services and merchandise as you desire, and that you have the legel right to arrange the funeral services for the deceased named above.

ACKNOWLEDGEMENT OF DISCLOSURES/DISCLAIMER

The Federal Trade Commission Trade Regulation Rule on "Funeral Industry Practices" requires certain disclosures and prohibits misrepresentations. The following is a checklist we ask those we serve to read and sign to verify that the funeral arrangement conference was conducted in compliance with the Rule. You who made the arrangements for the funeral and final disposition of the above-named decedent do hereby attest to the following:

1.

You were given a General Price List effective on

prior to discussing funeral arrangements or the selection of any funeral goods or

 

services.

 

2.

You were shown a Merchandise Price List effective on

prior to discussing caskets.

3.

You were shown an Outer Burial Container Price List effective

prior to discussing burial containers.

4.You were advised that the law does not require embalming except in certain special cases.

5.You were not advised that embalming is required for direct cremations, immediate burial, or a closed casket funeral without viewing or visitation if refrigeration is available, where state or local law does not require embalming in such cases.

6.You were not advised that any law requires a casket for direct cremation or that any container, other than an alternative container, is required for direct cremation.

7.You were advised that state law does not require the purchase of an outer burial container or any of the funeral goods or services you selected except as set forth on your Statement of Funeral Goods and Services Selected/Purchase Agreement.

8.No claims were made to you as the merchandise or services (embalming, casket, outer burial container) to the effect that embalming or the use of any merchandise available from us would delay the decomposition of the remains for a long term or indefinite time, or that any such merchandise would protect the body from gravesite substances. No representations or warranties were made to you about the protective features of caskets or outer buriel containers other than those made by the manufacturer. The only warranties were made to you about the protective features of caskets or outer burial containers other than those made by the manufacturer. The only warranties, expressed or implied, granted in connection with goods sold with the funeral service we arranged were the expressed written warranties. If any, extended by the manufacturers of such goods. No other warranties were extended to you.

9.You were advised that the funeral firm's cost for the items listed in Part One, Section II, may be different based on volume or cash discounts or other professional/trade customs where permitted by state or local law.

NOTICE TO BUYER/CO - BUYER

NOTICE: BY SIGNING THIS AGREEMENT, YOU ARE AGREEING THAT ANY CLAIM YOU MAY HAVE AGAINST THE SELLER SHALL BE RE- SOLVED BY ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A COURT OR JURY TRIAL AS WELL AS YOUR RIGHT OF APPEAL.

ACCEPTED FOR SELLER:

B :

license #

Executed this

day of

, 20

Signature (1)

Social Security #

How to Edit Statement Of Funeral Goods And Services Form Online for Free

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When it comes to fields of this precise PDF, here is what you need to do:

1. To start off, when completing the funeral agreement services, begin with the part with the next blank fields:

statement of funeral goods and services pdf conclusion process detailed (portion 1)

2. Immediately after the last part is done, proceed to enter the relevant information in these - SECTION I SERVICES AND MERCHANDISE, FUNERAL DIRECTOR AND STAFF SERVICES, MERCHANDISE, CasketCremation Casket cid, Professional Service Fee cid, Item No cid, CARE OF PREPARATION OF REMAINS, Refrigeration cid, Alternative container cid, Outside enclosure cid, Other preparation cid, cidItem No cid, TRANSPORTATION, Transferring remains to crematory, and Additional Transportation.

Filling in segment 2 in statement of funeral goods and services pdf

3. The following portion is focused on cid, cid TOTAL SECTION II cid, and TOTAL AMOUNT DUE cid - type in each of these blank fields.

How one can complete statement of funeral goods and services pdf portion 3

4. This next section requires some additional information. Ensure you complete all the necessary fields - Name of Deceased cid, Agreement No cid, STATEMENT OF FUNERAL GOODS AND, PART TWO OF TWO PARTS, TOTAL CHARGES cid, Less cash received cid, Less assignment ofreceivable from, Less assignment of cid, Unpaid balance due by cid, cid, cid, PAYMENT TERMS You understand that, IDENTIFICATION AND DESCRIPTION OF, You confirm that you have examined, and ACKNOWLEDGEMENT OF - to proceed further in your process!

STATEMENT OF FUNERAL GOODS AND, Less assignment of cid, and PAYMENT TERMS You understand that inside statement of funeral goods and services pdf

5. The last notch to finalize this form is critical. Make sure to fill out the appropriate form fields, like The Federal Trade Commission Trade, You were given a General Price, services, You were shown a Merchandise, refrigeration is available where, You were not advised that any law, cremation, You were advised that state law, as set forth on your Statement of, No claims were made to you as the, You were advised that the funeral, professionaltrade customs where, NOTICE BY SIGNING THIS AGREEMENT, NOTICE TO BUYERCO BUYER, and ACCEPTED FOR SELLER, prior to using the document. Neglecting to do so could end up in an incomplete and probably unacceptable form!

Part number 5 for submitting statement of funeral goods and services pdf

A lot of people frequently make some errors while completing cremation in this section. Remember to review what you type in here.

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