Service Request Form

Service Request Form

We know this may be a difficult time. This form is designed to gently guide you through requesting water cremation services. Completing the form below will help us understand your needs and ensure we handle every detail with care. Once submitted, we will prepare an invoice based on your selections and follow up with next steps to make this process as seamless as possible.
Pet Parent Name*

First NameLast Name
Pet Parent Phone Number*
Please enter a valid phone number.
Pet Parent Email Address*
example@example.com
Pet Parent Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
If you are not working with a veterinary clinic, you may leave the following section blank and continue to pet information.
Veterinary Clinic Name
Veterinary Clinic Contact Phone
Please enter a valid phone number.
Pet Name*
Pet Gender *
Pet Species*
Pet Breed (if known)
Pet Color*
Estimated Pet Weight *
Cremation Type*
Private Water Cremation
Communal Water Cremation
Mango Urn $25 Each
Clay Paw Print $29 Each
Transportation Selection*
Please note: If you choose for us to pick up your pet companion from your home, an additional transportation fee will apply. We’ll include this in your invoice and confirm all details before proceeding.
Return of Remains (if applicable)
Please note: If you’d like your pet companion’s ashes returned to your home or shipped via FedEx, an additional fee will apply. We’ll outline this clearly in your invoice before finalizing arrangements.
At-Home Euthanasia: Would you like us to coordinate compassionate at-home euthanasia services with one of our trusted veterinary partners?

Yes, I would like support with at-home euthanasia.
Authorization & Acknowledgment*

By signing this Authorization Form, I/we confirm that I/we have the legal right to control the disposition of our pet’s remains. I/we have voluntarily chosen Eternal Water Cremation and understand that the process is final and irreversible. I/we also understand that the return of our pet’s remains may take up to two weeks, as we prioritize a gentle and respectful process every step of the way.
Type Your name to Sign*
Date

MonthDayYear
Date
Should be Empty: