Cremation Order Form – Bell Mortuary

Funeral Home *Please enter funeral home, if any, where service is being conducted.

Deceased Name *

Casket or Cremation Tray? *Will the deceased be delivered / picked up in:CasketCremation TrayOther

Purchase Cremation Tray?A cremation tray is required to complete cremation.YesNo

Date of Death *

Time of Death

Hours

Minutes

AM/PM

Will Bell Mortuary Pick Up Deceased, Or Will Referring Mortuary Drop Off? *Pick UpDrop Off

Wil Additional Staff Be Needed For Removal? *YesNo

Will Deceased Need To Be Held Prior To Cremation? *YesNo

If Known, How Long Does Deceased Need To Be Held? *

Expedited Cremation Service? *Additional charges apply for expedited cremations.YesNo

Cremains Availability TimeframeAvailability dependent upon receipt of deceased and all necessary paperwork.24 Hours48 Hours72 Hours

Does Deceased Have A Pacemaker That Needs Removed? *YesNo

Does Deceased Weigh More Than 400 Pounds? *YesNo

Will A Representative Be Witnessing Cremation? *YesNo

WitnessFamilyFuneral Home Representative

Is A Temporary Container Needed For Cremains? *YesNo

Upgrade Cremains Container?YesNo

Will Cremains Be Shipped? *YesNo

Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Contact Name *

Contact Phone *

Contact Email Address