Goods and Services Contract Online Service Contract Form with Payment This is an AGREEMENT between you, the purchaser, and the funeral provider concerning services and merchadise. ARRANGEMENTS FOR:What's your file number?(Required) Deceased Name(Required) Given Name(s) as seen on birth certificate Last Deceased Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PURCHASER: Name of Purchaser(Required) Given Name(s) as shown on identification Email(Required)for receiving order confirmation Enter Email Confirm Email Billing Address of Purchaser(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Check Yes If The Person Authorizing Disposition is Different From Purchaser Yes No PERSON AUTHORIZING DISPOSITION:Name of Person Authorizing Disposition(Required) Given Name(s) as seen on Identification Last Address of Person Authorizing Disposition(Required) Street Address Address Line 2 City PURCHASING AGREEMENT PROFESSIONAL & STAFF SERVICES (Embalming is not required by law) Price: COMPLETING DOCUMENTS Price: TRANSFER SERVICES Price: FACILITIES - GENERAL Price: CREMATION FEE Price: CPBC ADMINISTRATIVE FEE Price: SHIPPING FEE Price: DEATH CERTIFICATE (Non-taxable) Price: NOTARIZED COPY OF DEATH CERTIFICATE ($20.00 each added to final total) Quantity Price: $ 20.00 CAD Quantity CREMATION CERTIFICATE ($20.00 each added to final total) Quantity Price: $ 20.00 CAD Quantity Total Mandatory Fees (Excluding GST)ADDITIONAL SERVICES:Check Yes If Cremation required sooner than 4 business days including day of arrangement Yes Cremation required sooner than 4 business days Price: Check Yes If Witness Cremation Required Yes Witness Cremation (8:30 A.M. Only) Price: Check Yes If Letter of Contents Required Yes Letter of Contents Price: Check Yes If Cremation Tray (when remains weigh in excess of 220 pounds) Required Yes Cremation Tray Price: CASKET UPGRADE Product Gallery Link(excluding PST)Casket Upgrade ChoicesnoneBelmont BirchBasic Legacy OakDiamond AspenFaith Wood BarMinor Wood BarHorizon BirchTransporter BlueBelmont Birch Price: Basic Legacy Oak Price: Diamond Aspen Price: Faith Wood Bar Price: Minor Wood Bar Price: Horizon Birch Price: Transporter Blue Price: Add Urn Product Gallery Link(excluding PST)Urn Upgrade ChoicesnoneAthenian LeafLangleyTraditionalAthenian Leaf Price: Langley Price: Traditional Price: Add Scattering Urns Product Gallery Link(excluding PST) Scattering Urn Upgrade ChoicesnoneReflectionsJourney (For Water Scattering)DoveGolfballRainbowReflections Price: Journey (For Water Scattering) Price: Dove Price: Golfball Price: Rainbow Price: PST (applies to all upgrades) Price: $ 0.00 CAD GST (applies to all items except death certificates) Price: $ 0.00 CAD Total Fees (Plus Applicable Taxes) Terms & Conditions The purchaser authorizes OKANAGAN INVESTMENT GROUP INC. to perform the requested services and furnish the merchandise indicated and supply any other items incidental to the requested services. When the contract is signed by the purchaser at any place other than the funeral provider’s place of business and the contract has not been substantially performed, the purchaser has 24 hours in which to cancel the contract, without penalty, but subject to payment for services provided to the time of cancellation. If the funeral provider must substitute goods or services previously contracted for under the Service Contract, the funeral provider must inform the purchaser and the purchaser may cancel that part of the contract. The purchaser and the person authorizing disposition hereby appoints, by way of his/her signature on this agreement, OKANAGAN INVESTMENT GROUP INC. to act as his/her agent in the procurement of certain services for the sole purpose of conducting the services outlined in this agreement. The purchaser agrees to pay to OKANAGAN INVESTMENT GROUP INC. the total balance due on execution of this agreement. If payment is not received in full on execution of this agreement a charge of 1-½% per month (18%per annum) will be applied to any balance due, until full payment is received. A funeral provider in the Province of British Columbia must pay to the Business Practices and Consumer Protection Agency (CPBC), as a part of the fees payable for the funeral provider's licence to operate, administrative fee for each death registered in the Province of British Columbia under the Vital Statistics Act by a funeral director employed by or under contract to the funeral provider. Human remains will be sheltered, pending disposition, at Cypress Funeral & Cremation Services ®, 2980 Smith Drive, Armstrong, BC, V0E 1B1.Purchaser - Authorized Signature(Required) Full Legal Name Today's Date Disposition - Authorized Signature(Required) Full Legal Name Today's Date Credit Card PhoneThis field is for validation purposes and should be left unchanged. Δ
