Client Cremation Authorization

CLIENT CREMATION AUTHORIZATION

Release of Deceased Animal Remains
4211 Smith Street - Suite A
Bacliff, TX 77518

832.568.3637
Location of Animal Remains:*
**Please note that selecting home pick-up will add an additional $$cost to the service. Pickup fee varies by WEIGHT of pet**
Clinic name:
Clinic Name
Clinic address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet's Name*
Date of Death:*

MonthDayYear
Breed Type:*
Pet Weight:*
Pet's Owner:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number (cell):
Please enter a valid phone number.
Phone Number (home):
Please enter a valid phone number.
Does your pet have a pacemaker?

YesNo
Collars/Toys/Bedding Disclaimer:

Please note that ANY collars, toys or bedding (blankets, pillows, carriers, etc) will be assumed to be included with the cremation of the pet. Be sure NOT to release pets with items that you wish to maintain as keepsakes. Four Paws Pet Cremation Houston and its associates are NOT responsible for unreturned items.
Pick all that apply:*

PRIVATE: Only pet in chamber, ashes returned to ownerCOMMUNAL: Cremains not returned to owner, but spread in a natural settingREMOVAL: Weekday night - starts at $65REMOVAL: Weekends/holidays - starts at $75REMOVAL: Out of Town - $100+RUSH SERVICE (24 hours)Clay Paw PrintSpecial UrnsEngraved Name PlateLock of Fur
Additional comments or requests:
File Upload

You may upload a photo of your pet. Please be sure this is the photo you wish to use for any products or services such as, photo urns, charms or viewing service.
Cancelof
I authorize the release of the above deceased animal to FOUR PAWS PET CREMATION SERVICE for the cremation of the type checked above.

I certify that the animal has not bitten anyone in the last 15 days. I agree to pay all the fees and charges incurred for the cremation process.

I also agree to allow a representative of Four Paws Pet Cremation Service to spread the ashes if I do not set up or follow through on arrangements to pickup my pet's cremains within 30 days from the date of the submission of this form.
Signature*
I am the:*

Pet OwnerAgent
FOUR PAWS PET CREMATION SERVICE USE ONLY
Cremation:
Removal:
Urn:
Engraving:
Clay Paw Print:
Lock of Fur:
Other:
Sales Tax:
TOTAL:
Form of payment:

Credit CardCheckCash
Should be Empty:

CLIENT CREMATION AUTHORIZATION