Disclosure Disclaimer Form2018-08-30T17:25:08+00:00

Federal Trade Commission (FTC) Disclosure/Disclaimer Form

The Federal Trade Commission’s Funeral Industry Practices RULE requires certain disclosures and prohibits misrepresentations.  This Disclosures/Disclaimer Form is a checklist we ask those we serve to read and sign if during the funeral arrangements our firm complied with the following.

Name of Deceased:

Date of Death

  1. The undersigned received a General Price List effective on: January 20, 2014 prior to discussing prices, services or caskets.
  2. The undersigned received a Casket Price List effective on: February 4, 2014 prior to viewing or discussing prices or caskets.
  3. The undersigned received an Outer Burial Container Price List effective on: February 5, 2014 prior to viewing or discussing prices of outer burial containers.
  4. The undersigned were not told that embalming is required by law and were told that the law does not require embalming except in certain cases. If embalming was provided, it was done with the permission of the undersigned.
  5. The undersigned were not told that any law requires embalming for direct cremations, immediate burials, or if refrigeration is available and the funeral is without viewing or visitation.
  6. The undersigned were informed that the law does not require a casket for direct cremation.
  7. The undersigned were informed that the law does not require the purchase of an outer burial container.
  8. The funeral home made no representations to the undersigned embalming or the use of any merchandise available for the funeral home would delay the decomposition of the remains for a long time or indefinite time. The undersigned understands that the funeral home has disclaimed all warranties with regard to caskets, outer burial containers, and other merchandise sold by the funeral home. The undersigned further understands that the only warranties express or implied, granted in connection with the goods sold by the funeral home are the express written warranties, if any, extended by the manufacturers of the goods. No other warranties, including the implied warranties of the merchantability or fitness for a particular purpose are extended by the funeral home.
  9. The undersigned were informed that the amount of each of the cash advance items were the cost to the funeral home. We were told the cost might be different based on volume or cash discounts or other professional/trade customs.

Done this:

Email Address:


Person(s) making final Arrangements:

Signature of purchaser



Signature of purchaser



Signature of purchaser