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This form gives permission to transfer the deceased from the place of death to our facility.
Credit Card Information
Please enter your credit card information. Your card will NOT be charged at this time upon submission of the form.
I, the undersigned, hereby authorize and give permission to the Cremation Society of New Hampshire or their designated agent to transfer the deceased from the place of death to their facility. I further authorize that I have the legal authority to make this decision and accept full financial responsibility for paying for the cremation. I acknowledge that I am providing a credit card number only to secure services, and that my credit card will not be charged prior to speaking with a cremation counselor regarding my preferred payment method. If I fail to proceed with cremation arrangements in a timely fashion, or refuse to communicate with my cremation counselor, I authorize this card to be charged for the full amount of services rendered.
By signing this form, I hereby acknowledge that a General Price List (GPL) has been made available to me either online or in-person and have I reviewed the GPL. Upon payment, the Cremation Society of New Hampshire agrees to provide the purchaser a Statement of Goods and Services either electronically or in person as soon as feasibly possible.
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