Pet Cremation In-Take Form

Pet Cremation In-Take Form

We are deeply sorry for the loss of your beloved pet. We understand how difficult this time can be and want to offer you compassionate support as you make final arrangements. This form is designed to help guide you through the cremation process with ease. Please provide as much detail as possible, and our team will reach out if there are any questions. If you need assistance, please don’t hesitate to contact us—we are here for you. Please call us at 989-773-5616 for assistance or afterhours arrangements.
Date

MonthDayYear
Date
Owners Name

First NameLast Name
Type of Pet*

DogCatBirdRabbitOther
Name of Pet*
Weight of Pet *
Owner Email*
example@example.com
Owner Phone Number*
Owner Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet Pickup Details

Please choose the date and time to drop your pet off or the location for your pet to be picked up by our staff. Please note home pickup, afterhours and vet charges below. Please call us at 989-773-5616 to confirm afterhours arrangements.
Dropoff or Transportation Arrangements

Dropoff (Monday - Friday 9am-5pm)Home Pickup: $95 within 15 miles. Pickup beyond 15 miles will incur a $3.50 charge per mile. Monday - Friday 5-8pm or Sat/Sun 9am-1pm. Please call us at 989-773-5616 to confirm afterhours arrangements.Afterhours Dropoff: $75 Monday - Friday 5pm-8pm or Sat/Sun 9am-1pm. Please call us at 989-773-5616 to confirm afterhours arrangements.Vet Pickup $95 within 15 miles. Pickup beyond 15 miles will incur a $3.50 charge per mile. Monday - Friday 9am-5pm.Other (please call our office at 989-773-5616 to discuss specifics)
Location For Pickup (if applicable)
Please indicate where you'd like us to pickup at your home or vet office, etc.
Date of Pet Pickup or Dropoff*

MonthDayYear
Date
Time of Pet Pickup or Dropoff*

Hour Minutes

AM/PM Option
Address For Pickup (if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CREMATION PRICING, TRANSPORTATION AND MERCHANDISE OPTIONS

We offer cremation services with pricing based on the weight of your pet, along with convenient drop-off and pickup options. Each cremation includes your choice of one of three urn options, with additional memorial items available to help you honor your beloved companion. Below, you will find details on cremation pricing, home and veterinary pickup, and available keepsakes and urns.
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Home PickupMonday - Friday 9:00am - 8:00pm or Saturday/Sunday 9:00am - 1:00pm Pickup beyond 15 miles will incur a $3.50 charge per mile. *Mileage will be calculated upon submission. Please call us at 989-773-5616 to confirm afterhours arrangements.
$95.00 Quantity
Item subtotal:$0.00



After Hours DropoffMonday - Friday 5:00pm - 8:00pm or Saturday/Sunday 9:00am - 1:00pm Please call us at 989-773-5616 to confirm afterhours arrangements.
$75.00 Quantity
Item subtotal:$0.00



Vet PickupMonday - Friday 9:00am - 5:00pm Pickup beyond 15 miles will incur a $3.50 charge per mile. *Mileage will be calculated upon submission.
$95.00 Quantity
Item subtotal:$0.00



Pocket PetSmall hampster, bird, etc.
$110.00 Quantity



Pet Weight................... 1 - 15lbs
$230.00 Quantity



Pet Weight................... 16 - 30lbs
$250.00 Quantity



Pet Weight................... 31 - 50 lbs
$270.00 Quantity



Pet Weight.................. 51 - 75 lbs
$290.00 Quantity



Pet Weight................... 76 - 99 lbs
$310.00 Quantity



Pet Weight................... 100 - 150 lbs
$330.00 Quantity



Pet Weight................... 151 - 200 lbs
$350.00 Quantity



Pet Weight................... Over 200 lbs
$380.00 Quantity



Urn SelectionsFree with cremation and can be customized with purchase of name plate.
$ Free QuantityUrn Option
Item subtotal:$0.00



Ink Paw PrintIncluded with cremation.
$ Free Quantity
Item subtotal:$0.00



Clay Paw PrintSelect gold or silver.
$30.00 QuantityColor
Item subtotal:$0.00



Customized Name Plate** Please complete customization details below.
$35.00 Quantity
Item subtotal:$0.00



Always In My Heart NecklaceEach piece of jewelry comes filled with you pets ashes as well as a 22" chain.
$50.00 Quantity
Item subtotal:$0.00



Heart Paw NecklaceEach piece of jewelry comes filled with you pets ashes as well as a 22" chain.
$50.00 Quantity
Item subtotal:$0.00



Intertwining Circles and Pawprint Heart NeclaceEach piece of jewelry comes filled with you pets ashes as well as a 22" chain.
$50.00 QuantityColor
Item subtotal:$0.00



Dog TagEach piece of jewelry comes filled with you pets ashes as well as a 22" chain.
$50.00 QuantityColor
Item subtotal:$0.00



Subtotal

$0.00

Tax

$0.00

Total

$0.00
*Mileage

Please note that incurring mileage costs will change total.
** Name Plate Customization Details (if applicable)
Please provide pet name along with year of birth and death. Ex. Sparky, 2015 - 2025
PAYMENT METHOD

Payment must be completed prior to your pet being in our care. If you are bringing your pet to our facility, payment must be made at the time of drop-off. We accept cash, checks, and credit cards. Please note that a 3% processing fee applies to credit card payments.
Method of Payment Selected

CashCheckCredit Card (add 3% processing fee)
Other Information You Would Like Us To Know
Authorization to Cremate

We understand that making final arrangements for your beloved pet is a deeply personal and emotional decision. To ensure that your wishes are honored and that we proceed in accordance with your instructions, we require a signed authorization before cremation can take place. As part of this authorization, you will be asked to check the required boxes to confirm that you understand the cremation process and our policies.
I hearby authorize Mt. Pleasant Pet Cremation Service to arrange for the private cremation of my pet. I understand that I must recover the cremated remains within thirty (30) days of the date of cremation. Mt. Pleasant Pet Cremation Service takes no responsibility for cremated remains where no permanent provisions have been made within a thirty (30) day period for the disposition of the cremated remains and reserves the right to dispose of cremated remains after such period*

Yes
Cremated remains consist primarily of bone fragments, which are processed after cremation to permit their placement in an urn or other suitable container. The obligation of the Mt. Pleasant Pet Cremation Service shall be limited to the cremation of the pet and disposition of the cremated remains. The undersigned agrees to hold harmless and release Mt. Pleasant Pet Cremation Service, its agents, and employees from any and all loss, damages, liability, and cause of action in connection with the cremation and disposition of the cremated remains as authorized herein.*

Yes
I understand that the cremation process and return of my pet's cremains may take up to two (2) weeks.*

Yes
Signature*

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