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 of Death

MonthDayYear
Date
Owners Name

First NameLast Name
Type of Pet

Other
Name of Pet
Weight of Pet
Owner Email
example@example.com
Owner Phone Number
Format: (000) 000-0000.
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will you be bringing your pet in a cremation-ready container (carboard box or bag), or shall we have one ready for you when you arrive?
Pet Pickup Details

Please choose the date and time to drop off your pet.
Dropoff Arrangements
Date of Pet Dropoff

MonthDayYear
Date
Time of Pet 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 and available keepsakes and urns.
** Name Plate Customization Details (if applicable) ($35)
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
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
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.
I understand that the cremation process and return of my pet's cremains may take up to 14 business days
Signature
*Please select a complementary urn*
prevnext( X )
Pocket Pet
Small 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 Selections
Free with cremation. Please choose from the four options below.

Free QuantityUrn Option
Item subtotal:$0.00



Ink Paw Print
Included with cremation. (If obtainable)

Free Quantity
Item subtotal:$0.00



Clay Paw Print
Select 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 Necklace
Each piece of jewelry comes filled with you pets ashes as well as a 22" chain.

$50.00 Quantity
Item subtotal:$0.00



Heart Paw Necklace
Each 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 Neclace
Each piece of jewelry comes filled with you pets ashes as well as a 22" chain.

$50.00 QuantityColor
Item subtotal:$0.00



Dog Tag
Each piece of jewelry comes filled with you pets ashes as well as a 22" chain.

$50.00 QuantityColor
Item subtotal:$0.00



After Hour Drop Off
Monday–Friday:

4:30 PM – 8:00 PM

Saturday/Sunday:

9:00 AM – 1:00 PM

Please call us at 989-773-5616 to confirm afterhours arrangements.

$75.00 Quantity



Total

$0.00
Should be Empty:

Pet Cremation In-Take Form

Pet Pickup Details

CREMATION PRICING, TRANSPORTATION AND MERCHANDISE OPTIONS

PAYMENT METHOD

Authorization to Cremate

*Please select a complementary urn**

Please select a complementary urn