Estimated Statement of Funeral Goods and Services
Tri-State Cremation Society of Delaware Valley
412 Philadelphia Pike, Wilmington, DE 19809
(302) 764-2900   •   fax (302) 764-6281
NAME:
 
SERVICE CHARGES
Basic services of Funeral Director and Staff
$
 
Embalming Care
$
 
Dressing/Casketing/Cosmetology
$
 
Refrigeration
$
 
Facilities and Equipment
$
 
Transportation
$
 
Cremation Care
$
 
Witnessing Cremation
$
 
Viewing/Visitation ( ) Hours
$
 
Funeral Ceremony
$
 
Memorial Services
$
 
Graveside Service
$
 
Transfer of Remains
$
 
Funeral Coach
$
 
Forwarding of Remains
$
 
Receiving of Remains
$
 
Other
$
 
Other
$
 
TOTAL SERVICE CHARGES
$
 
MERCHANDISE
Urn
$
 
Keepsake/Jewelry
$
 
Limousine
$
 
Prayer Cards/Memorial Folders
$
 
Register Book
$
 
Service Programs
$
 
Hairdresser
$
 
Video Tribute
$
 
Florist
$
 
Cemetery/Inscriptions
$
 
Shipping Container/Air tray
$
 
Other
$
 
TOTAL MERCHANDISE CHARGES
$
 
MONIES ADVANCED BY FUNERAL HOME
Cemetery Opening & Closing
$
 
Cemetery Overtime
$
 
News Journal Funeral Notice
$
 
Other Funeral Notice
$
 
Church Honorarium
$
 
Clergy Honorarium
$
 
Organist
$
 
Soloist
$
 
Certified Copies
$
 
Other Funeral Home Charge
$
 
Airfare
$
 
Pallbearers
$
 
Other Cash Advanced
$
 
TOTAL MONIES ADVANCED
$
 
CREDITS
$
 
TOTAL ESTIMATED FUNERAL COST
$
 
THIS IS AN ESTIMATED BILL
I/We jointly and severally authorize Tri-State Cremation Society of Delaware Valley remove and prepare the above-named deceased, and do agree to become responsible for the payment of the above funeral expenses, and also agree that any additional items ordered become part of this agreement. The liablility hereby assumed is in addition to the liability imposed by law upon the estate and others. A FINANCE CHARGE at the rate of one and a half percent (1.5%) per month (ANNUAL PERCENTAGE RATE OF 18%) will be added to the unpaid balance after 30 days from date of death.

Payment Terms:
 

 

 

Agreed and Accepted:
 

dated:
 

Reason for Embalming:
 

 

 

Accepted by:
 

Tri-State Cremation Society of Delaware Valley

dated:
 

In accordance with the Federal Trade Commission, Trade Regulation Rule for the Funeral Industry Practice, Tri-State Cremation Society makes the following statements related to Funeral Goods and Services Selected.
1.
Charges for only those items that are 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 reason(s) in writing below.
2.
If you selected a funeral that may require embalming, such as a funeral with a 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.
3.
If any cemetery or crematory regulations have required the purchase of any items, the regulation is explained below.
 
Explanations:
 
1.
General
 
2.
 

 
3.
Reasons for Embalming
a.
Board of Health Regulation
b.
Viewing
c.
Both A & B
4.
Cemetery regulations require use of outside receptacle or crematory regulations require use of container.