Start Your Arrangements

What would you like to do today?

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Choose Your Package

Where is the person for whom arrangements are being made currently located?
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Required Cash Advances

All Cremation services require payment for the following two options.

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This is the cost charged to us by the Crematory. It also includes the cost of the cremation container into which the body is placed.

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State law requires the county coroner to authorize every cremation. This fee is set by the county and is required to obtain the necessary permit allowing the cremation of a body.

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Cremation Add Ons

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If you would like to discuss your arrangements in person, please select the "Meet with Director" option.

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Service Add ons

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Direct Burial only includes drop off of body to cemetery for burial. If you wish to have a private or religious service or gathering at the cemetery prior to body being interred, Graveside Service is required as our staff must be present.

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Additional Options

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Death Certificates

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Transportation Options

For the convenience of the family, we can provide car service to/from the cemetery from our funeral home.

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Obituary

An obituary is not legally required. 

The Newsaper Obituary options below include our $75 fee to arrange, compose, proofread, prepare, and submit your obituary to the newspaper. Cost shown to publish an obituary in a newspaper is the base price set by the Reading Eagle and is ONLY an estimate, not inflation proof, and final cost will be determined when the obituary is submitted to the newspaper at the time of death. Essentially you are placing a "deposit" towards the final cost of the obituary. Newspaper obituary costs vary widely from paper to paper. Including a photo with the obituary also increases costs.
 
The Reading Eagle's Base package includes up to 4" depth obituary (21 lines), 1 photo, and listing on Legacy.com. The Best package addiitonally includes a 5x7-mounted keepsake replica of the obituary.
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Other Obituary Options

Feeney Website: Our website obituary, which appears on www.johnpfeeney.com, allows friends and family to leave condolences, light a candle and purchase flowers and other gifts. A photo is included for free. There is no limit on the length of the obituary. Online obituaries are customized with a header image and music. If you chose to include a Memorial DVD with your arrangements, images from the DVD are added automatically to your online obituary. Guests can also upload their own photos and videos and share the obituary to facebook, twitter, and email as well as print out the obituary and guestbook entries. You can also include an option for guests to directly donate to the charity of your choice or to a charity of their choosing in lieu of sending flowers or other gifts. Your obituary remains on our website indefinitely.

BerksObits: In addition to placing your obituary on our funeral home website, your obituary listing will also appear on BerksObits.com, a county-wide aggregate obituary site, which is promotes local obituaries on facebook and delivers them daily via email to subscribers.

As the Reading Eagle's prices are soaring and their circulation is dwindling, BerksObits provides an economical alternative and added reach for your family and friends to find the obituary. 

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Urns

After the cremation has been completed, the cremains are returned to our funeral home in the vessel of your choosing. The corrugated box containing a plastic bag with the cremains is the standard vessel included with all packages. You can select from the options below to upgrade your vessel. Minimum vessel requirements for burial are set by each cemetery. The vessel may be upgraded at any time after death. Keepsake containers and jewelry containing cremains can also be purchased.
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Urn Options

Corrugated Box

Mailer Niche Container

Tin

Stone burial urn

Marble Burial Urn

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Stone Urn Colors

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Marble Burial Urn Colors

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Caskets

Please note: The casket included in all of our packages is standard size. For persons taller than 6'10" or heavier than 350lbs, an extra large casket will be required. For very obese people (800+ lbs), a specialty casket is needed. Please select the appropriate size below. 
If weight should differ at the time of death, adjustments will be made to your final bill.

Casket included with Direct/Green Burial Package is a biodegradeable cloth/cardboard casket. Additional options are available at added cost.

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Metal casket not suitable for Green Burial.

Direct/Green Casket Options

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Casket Colors

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Biographical Information

The following pages will ask you several questions about who these arrangements are for along with additional biographical information. It may take some time to complete. You may find it easier to use a computer for this section versus a mobile device. You will have a chance to review the information you have entered and can use the BACK button at the bottom of each page to return to previous sections. Do not use your browser's back button as your form enteries will be lost.

The "Save" button below allows you to save your entries and return later to complete this application. It does not submit the form. On the last page you must click the "SUBMIT" button to finalize your Application. If you do not see a message stating your form was submitted successfully, your form has not been received.

Please call us at 610-372-4160 with any questions regarding the completion of this form.

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Who Are These Arrangements For?

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Enter "Unknown" if not known.

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Signability

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e.g., Debbie instead of Deborah

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Do not include #, Apt, Room, Route, Box or other indicator. E.g. 124 not #124 or Apt 124

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Verify address appears correctly. Adjust your entry above to update full address.

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Please enter a real email address. This email will be used when sending documents.

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Leave blank if you do not know or do not wish to provide online.

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Leave blank if you do not know or do not wish to provide online.

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Please check accuracy of age.

Pacemaker

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Father/Parent 1

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Mother/Parent 2

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Last Name prior to 1st Marriage. Enter "Unknown" if not known.

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For the occupation/job title you entered above, in what industry was this position held? Examples: Telecommunications, Medicine, Manufacturing, Restaurant, etc. If homemaker, enter "Own Home." 

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Military Benefits

In order to establish eligibility for Veteran benefits, a copy of the Veteran's discharge papers (DD214) must be submitted. Please mail or drop off a copy to our funeral home.

If you do not have your DD214, we can still assist you in determining your eligibility if you are interested in burial at a National Cemetery, such as Indiantown Gap. 

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Spouse Information

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Last Name prior to 1st Marriage. Enter "Unknown" if not known.

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Leave blank if unknown or unwilling to provide online.

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Leave blank if unknown or unwilling to provide online.

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Address

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Next of Kin

Who is Your Next of Kin? 
Next of Kin refers to a person's closest living relative. Order of Kinship: Spouse, Children, Grandchildren, Great-grandchildren, Parents (if still living and in absence of any offspring or when offspring are under 18), Siblings, Nieces/Nephews, Aunt/Uncles (in absence of any siblings and their offspring)
If you have no living relatives, please list the person most likely to report your death or handle your final arrangements.
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Please enter a valid email address. This email will be used for sending documents.

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We are required to collect your social security and birthdate for the completion of preneed documents since you indicated you will be signing the documents. This information is encrypted and stored securely upon form submission.

IMPORTANT: SSN and birthdate will be automatically inserted into documents when this form is submitted. Inaccurate or bogus SSNs will invalidate your documents.

If you do not have, do not know, or do not wish to provide this information online, leave these fields blank. After submitting this form, please call the funeral home at 610-372-4160 to provide us with this information.
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Leave blank if unknown or do not wish to provide online.

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Leave blank if unknown or do not wish to provide online.

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E. COMMINGLING OF ASHES: THE AUTHORIZED REPRESENTATIVE(S) UNDERSTAND THAT, EVEN WITH THE EXERCISE OF REASONABLE CARE AND THE USE OF ITS BEST EFFORTS, THE COMPANY MAY NOT BE ABLE TO RECOVER ALL THE PARTICLES OF THE CREMATED REMAINS OF THE DECEASED AND SOME PARTICLES MAY INADVERTENTLY BECOME COMMINGLED WITH PARTICLES OF OTHER CREMATED REMAINS. THE AUTHORIZED REPRESENTATIVE(S) HEREBY EXPRESSLY AUTHORIZE THE INCIDENTAL OR INADVERTENT COMMINGLING OF PARTICLES OF CREMATED REMAINS OF THE DECEASED WITH PARTICLES OF OTHER CREMATED REMAINS IN THE CREMATION CHAMBER AND/OR OTHER DEVICES UTILIZED TO REDUCE THE CREMATED REMAINS AND THE DISPOSITION OF ANY REMAINING PARTICLES OF CREMATED REMAINS OF THE DECEASED AT THE SOLE DISCRETION OF THE COMPANY.

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F. DISPOSITION: THE AUTHORIZED REPRESENTATIVE(S) AGREE THAT IF PERMANENT ARRANGEMENTS FOR FINAL DISPOSITION OF THE CREMATED REMAINS ARE TO BE CARRIED OUT BY THE AUTHORIZED REPRESENTATIVE(S) OR THEIR DULY AUTHORIZED AGENT, AND SUCH ARRANGEMENTS HAVE NOT BEEN COMPLETED WITHIN 120 DAYS AFTER THE DATE OF THE AVAILABILITY OF SUCH CREMATED REMAINS FOR FINAL DISPOSITION, THE COMPANY OR THE FUNERAL HOME SHALL GIVE ANY WRITTEN NOTICE WHICH IS REQUIRED BY APPLICABLE STATE LAW, THROUGH REGULAR MAIL TO THE ADDRESS LISTED BELOW,. THEREAFTER THE COMPANY OR FUNERAL HOME IS AUTHORIZED AND DIRECTED TO DISPOSE OF THE CREMATED REMAINS IN ANY MANNER IT MAY DEEM SUITABLE, EITHER (I) 120 DAYS AFTER SUCH WRITTEN NOTIFICATION, IF WRITTEN NOTICE IS REQUIRED, OR (II) 120 DAYS AFTER THE AVAILABILITY OF SUCH CREMATED REMAINS FOR FINAL DISPOSITION, IF WRITTEN NOTICE IS NOT REQUIRED.

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G. LIABILITY: The obligation of the Company shall be limited to the cremation of the remains of the deceased and the disposition of the cremated remains as directed herein. The Authorized Representative(s) agree to release and hold the Company, the funeral home, its affiliates and their agents, employees and assigns harmless from any and all loss, damages, liability, judgments or causes of action (including attorney's fees and expenses of litigation) in connection with the cremation and disposition of the cremated remains as authorized herein or the failure of the Authorized representative(s) to identify properly the remains of the Deceased or take possession of or make permanent arrangements for the disposition of such remains.

THE PARTIES HEREBY AGREE THAT ANY DAMAGES, INCLUDING DAMAGES FOR ECONOMIC LOSS AND EMOTIONAL DISTRESS, AND OTHER COMPENSATORY OR PUNITIVE DAMAGES ARISING OUT OF THE ACTIONS OF THE PARTIES, OR THE TRANSACTION OR EVENTS RELATING DIRECTLY OR INDIRECTLY THERETO, ARE DIFFICULT TO DETERMINE AND IN LIEU THEREOF AGREE THAT LIQUIDATED DAMAGES IN THE AMOUNT OF THE COST OF THE CREMATION PROVIDED FOR HEREIN SHALL APPLY IN LIEU THEREOF.

THE COMPANY DOES NOT MAKE OR PROVIDE ANY EXPRESS OR IMPLIED WARRANTIES INCLUDING, BUT NOT LIMITED TO, ANY WARRANTY AS TO THE IDENTITY OF THE REMAINS, THE ACCOMPLISHMENT OF ANY GENERAL OR SPECIFIC RESULT OR THE METHODS OR PROCEDURES USED IN THE CREMATION PROCESS.

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Order Review

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Please note: Payment is required when you come to the funeral home to complete your arrangements, unless other arrangements, such as insurance assignment, have been agreed upon. Financing options are available with a required down payment of $1,500 (for contracts greater than $2,000) and credit score of 650 or higher in order to qualify.


TERMS - This is a CASH transaction with full payment due by day prior to the service, unless other terms are agreed to, in writing, by this funeral home. If such an agreement is reached, a rebilling fee of $20.00 per month & late charge at the rate of 1.5% per mo. will be added to unpaid accounts over 30 days. Annual rate is 18%.

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Please provide your Name, Phone and Email to have this Price Quote sent to you. Press the SUBMIT button below to submit this form.
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The email has been sent.

Your progress has been saved.

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Start Your Arrangements

What would you like to do today?

Current Situation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Choose Your Package

Where is the person for whom arrangements are being made currently located?
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Required Cash Advances

All Cremation services require payment for the following two options.

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Coroner Permit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Cremation Add Ons

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Service Add ons

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Additional Options

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Death Certificates

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Transportation Options

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Obituary

An obituary is not legally required. 

The Newsaper Obituary options below include our $75 fee to arrange, compose, proofread, prepare, and submit your obituary to the newspaper. Cost shown to publish an obituary in a newspaper is the base price set by the Reading Eagle and is ONLY an estimate, not inflation proof, and final cost will be determined when the obituary is submitted to the newspaper at the time of death. Essentially you are placing a "deposit" towards the final cost of the obituary. Newspaper obituary costs vary widely from paper to paper. Including a photo with the obituary also increases costs.
 
The Reading Eagle's Base package includes up to 4" depth obituary (21 lines), 1 photo, and listing on Legacy.com. The Best package addiitonally includes a 5x7-mounted keepsake replica of the obituary.
Newspaper Obituary {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Other Obituary Options

Feeney Website: Our website obituary, which appears on www.johnpfeeney.com, allows friends and family to leave condolences, light a candle and purchase flowers and other gifts. A photo is included for free. There is no limit on the length of the obituary. Online obituaries are customized with a header image and music. If you chose to include a Memorial DVD with your arrangements, images from the DVD are added automatically to your online obituary. Guests can also upload their own photos and videos and share the obituary to facebook, twitter, and email as well as print out the obituary and guestbook entries. You can also include an option for guests to directly donate to the charity of your choice or to a charity of their choosing in lieu of sending flowers or other gifts. Your obituary remains on our website indefinitely.

BerksObits: In addition to placing your obituary on our funeral home website, your obituary listing will also appear on BerksObits.com, a county-wide aggregate obituary site, which is promotes local obituaries on facebook and delivers them daily via email to subscribers.

As the Reading Eagle's prices are soaring and their circulation is dwindling, BerksObits provides an economical alternative and added reach for your family and friends to find the obituary. 

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Urns

After the cremation has been completed, the cremains are returned to our funeral home in the vessel of your choosing. The corrugated box containing a plastic bag with the cremains is the standard vessel included with all packages. You can select from the options below to upgrade your vessel. Minimum vessel requirements for burial are set by each cemetery. The vessel may be upgraded at any time after death. Keepsake containers and jewelry containing cremains can also be purchased.
Urn {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Urn Options

Corrugated Box

Mailer Niche Container

Tin

Stone burial urn

Marble Burial Urn

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Stone Urn Colors

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Marble Burial Urn Colors

Caskets

Please note: The casket included in all of our packages is standard size. For persons taller than 6'10" or heavier than 350lbs, an extra large casket will be required. For very obese people (800+ lbs), a specialty casket is needed. Please select the appropriate size below. 
If weight should differ at the time of death, adjustments will be made to your final bill.

Casket included with Direct/Green Burial Package is a biodegradeable cloth/cardboard casket. Additional options are available at added cost.

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Direct/Green Casket Options

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Casket Colors

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Biographical Information

The following pages will ask you several questions about who these arrangements are for along with additional biographical information. It may take some time to complete. You may find it easier to use a computer for this section versus a mobile device. You will have a chance to review the information you have entered and can use the BACK button at the bottom of each page to return to previous sections. Do not use your browser's back button as your form enteries will be lost.

The "Save" button below allows you to save your entries and return later to complete this application. It does not submit the form. On the last page you must click the "SUBMIT" button to finalize your Application. If you do not see a message stating your form was submitted successfully, your form has not been received.

Please call us at 610-372-4160 with any questions regarding the completion of this form.

Who Are These Arrangements For?

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Maiden Last Name: Last name at birth, prior to 1st marriage. (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Signability

{binding SignAbility_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Alias {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Street Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Apartment # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Zip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
County {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Pacemaker

{binding Pacemaker_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
As we prepare the body for the viewing, how would you like us to treat any facial hair? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Country of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
County of Birth (if known) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Father/Parent 1

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City and State of Residence (if known) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Mother/Parent 2

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Maiden Last Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City and State of Residence (if known) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Race {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Race {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Asian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Tribe {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Pacific Islander {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Spanish Origin {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Hispanic {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding Education_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding Occupation_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Industry {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding Branch_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Military Benefits

In order to establish eligibility for Veteran benefits, a copy of the Veteran's discharge papers (DD214) must be submitted. Please mail or drop off a copy to our funeral home.

If you do not have your DD214, we can still assist you in determining your eligibility if you are interested in burial at a National Cemetery, such as Indiantown Gap. 

Marital Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Spouse Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Maiden Last Name (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding SpouseAddressQ_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Address

Street Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Zip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Next of Kin

Who is Your Next of Kin? 
Next of Kin refers to a person's closest living relative. Order of Kinship: Spouse, Children, Grandchildren, Great-grandchildren, Parents (if still living and in absence of any offspring or when offspring are under 18), Siblings, Nieces/Nephews, Aunt/Uncles (in absence of any siblings and their offspring)
If you have no living relatives, please list the person most likely to report your death or handle your final arrangements.
First Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Middle Initial {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Last Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding AddressSame_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Street Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Zip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

{binding Informant_Label }

We are required to collect your social security and birthdate for the completion of preneed documents since you indicated you will be signing the documents. This information is encrypted and stored securely upon form submission.

IMPORTANT: SSN and birthdate will be automatically inserted into documents when this form is submitted. Inaccurate or bogus SSNs will invalidate your documents.

If you do not have, do not know, or do not wish to provide this information online, leave these fields blank. After submitting this form, please call the funeral home at 610-372-4160 to provide us with this information.
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Social Security {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Initials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

E. COMMINGLING OF ASHES: THE AUTHORIZED REPRESENTATIVE(S) UNDERSTAND THAT, EVEN WITH THE EXERCISE OF REASONABLE CARE AND THE USE OF ITS BEST EFFORTS, THE COMPANY MAY NOT BE ABLE TO RECOVER ALL THE PARTICLES OF THE CREMATED REMAINS OF THE DECEASED AND SOME PARTICLES MAY INADVERTENTLY BECOME COMMINGLED WITH PARTICLES OF OTHER CREMATED REMAINS. THE AUTHORIZED REPRESENTATIVE(S) HEREBY EXPRESSLY AUTHORIZE THE INCIDENTAL OR INADVERTENT COMMINGLING OF PARTICLES OF CREMATED REMAINS OF THE DECEASED WITH PARTICLES OF OTHER CREMATED REMAINS IN THE CREMATION CHAMBER AND/OR OTHER DEVICES UTILIZED TO REDUCE THE CREMATED REMAINS AND THE DISPOSITION OF ANY REMAINING PARTICLES OF CREMATED REMAINS OF THE DECEASED AT THE SOLE DISCRETION OF THE COMPANY.

Initials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

F. DISPOSITION: THE AUTHORIZED REPRESENTATIVE(S) AGREE THAT IF PERMANENT ARRANGEMENTS FOR FINAL DISPOSITION OF THE CREMATED REMAINS ARE TO BE CARRIED OUT BY THE AUTHORIZED REPRESENTATIVE(S) OR THEIR DULY AUTHORIZED AGENT, AND SUCH ARRANGEMENTS HAVE NOT BEEN COMPLETED WITHIN 120 DAYS AFTER THE DATE OF THE AVAILABILITY OF SUCH CREMATED REMAINS FOR FINAL DISPOSITION, THE COMPANY OR THE FUNERAL HOME SHALL GIVE ANY WRITTEN NOTICE WHICH IS REQUIRED BY APPLICABLE STATE LAW, THROUGH REGULAR MAIL TO THE ADDRESS LISTED BELOW,. THEREAFTER THE COMPANY OR FUNERAL HOME IS AUTHORIZED AND DIRECTED TO DISPOSE OF THE CREMATED REMAINS IN ANY MANNER IT MAY DEEM SUITABLE, EITHER (I) 120 DAYS AFTER SUCH WRITTEN NOTIFICATION, IF WRITTEN NOTICE IS REQUIRED, OR (II) 120 DAYS AFTER THE AVAILABILITY OF SUCH CREMATED REMAINS FOR FINAL DISPOSITION, IF WRITTEN NOTICE IS NOT REQUIRED.

Initials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

G. LIABILITY: The obligation of the Company shall be limited to the cremation of the remains of the deceased and the disposition of the cremated remains as directed herein. The Authorized Representative(s) agree to release and hold the Company, the funeral home, its affiliates and their agents, employees and assigns harmless from any and all loss, damages, liability, judgments or causes of action (including attorney's fees and expenses of litigation) in connection with the cremation and disposition of the cremated remains as authorized herein or the failure of the Authorized representative(s) to identify properly the remains of the Deceased or take possession of or make permanent arrangements for the disposition of such remains.

THE PARTIES HEREBY AGREE THAT ANY DAMAGES, INCLUDING DAMAGES FOR ECONOMIC LOSS AND EMOTIONAL DISTRESS, AND OTHER COMPENSATORY OR PUNITIVE DAMAGES ARISING OUT OF THE ACTIONS OF THE PARTIES, OR THE TRANSACTION OR EVENTS RELATING DIRECTLY OR INDIRECTLY THERETO, ARE DIFFICULT TO DETERMINE AND IN LIEU THEREOF AGREE THAT LIQUIDATED DAMAGES IN THE AMOUNT OF THE COST OF THE CREMATION PROVIDED FOR HEREIN SHALL APPLY IN LIEU THEREOF.

THE COMPANY DOES NOT MAKE OR PROVIDE ANY EXPRESS OR IMPLIED WARRANTIES INCLUDING, BUT NOT LIMITED TO, ANY WARRANTY AS TO THE IDENTITY OF THE REMAINS, THE ACCOMPLISHMENT OF ANY GENERAL OR SPECIFIC RESULT OR THE METHODS OR PROCEDURES USED IN THE CREMATION PROCESS.

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Order Review

Payment Method {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please note: Payment is required when you come to the funeral home to complete your arrangements, unless other arrangements, such as insurance assignment, have been agreed upon. Financing options are available with a required down payment of $1,500 (for contracts greater than $2,000) and credit score of 650 or higher in order to qualify.


TERMS - This is a CASH transaction with full payment due by day prior to the service, unless other terms are agreed to, in writing, by this funeral home. If such an agreement is reached, a rebilling fee of $20.00 per month & late charge at the rate of 1.5% per mo. will be added to unpaid accounts over 30 days. Annual rate is 18%.

Promo Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Balance Statement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please provide your Name, Phone and Email to have this Price Quote sent to you. Press the SUBMIT button below to submit this form.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }