Pet Cremation Authorization Form
I (owner's name)
First Name
Last Name
Phone #
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
example@example.com
Bridge Gate Pet Cremations
P.O. Box 83, Sand Lake, MI 49343
(616) 204-7504
office@bridgegatepc.com
as my trusted crematorium for the cremation of my beloved pet. I authorize a representative of their company to collect:
Pets Name:
Age:
Breed:
M
F
Weight:
Clinic Name:
To perform:
Communal
Semi-Private
Private:
Additional Items to be purchased:
Ink Paw Prints(s) (complimentary)
Ink Nose Print
Clay Paw Print(s)
Fur Clippings
Keychain
Photo Eng. Keychain
Necklace
Slate
Urn Selection
Back
Next
As owner or duly authorized agent of the pet described above I (we) authorize the above requested services.
Check to opt out of text message billing.
Owner's Signature:
Date:
-
Month
-
Day
Year
Date
Additional Notes
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Submit
Should be Empty: