Release and Financial Responsibility Form

Electronic Signature:

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.