Arrange Now Owner InformationName* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Pet InformationPet Name* First Species(Dog, cat, bird, etc.)Weight(approximately) Where is your pet now?HomeVet's officeOtherAddress for pickup: 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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Do you want the ashes returned?YesNoAdditional comments or requests?Terms of Service"I have authorized Heartland Pet Cremation, LLC and/or one of its affiliated companies (“Heartland Pet”) to care for the final arrangements of my pet. I understand the cremation is irreversible and final. If I have chosen not to have my pet’s cremated remains returned to me, I understand that my pet will become part of a group cremation. I understand these cremated remains will be irretrievable and will be scattered in a dignified manner. If I have chosen to have the cremated remains returned to me, I understand that this will be a private cremation that will include my pet having a unique identification number and tag that will accompany my pet throughout the cremation process to insure the integrity of the private cremation. I understand that Heartland Pet Cremation will hold the cremated remains for no less than thirty (30) days, during which time I or someone on my behalf will retrieve them or arrange their return. If no arrangements are made for the final disposition, release, or shipment of the cremated remains, or if Heartland Pet Cremation is unable to contact me using the information I have provided, I agree that Heartland Pet Cremation shall have the right to send the cremated remains to the addressed listed on the reverse side of this page for the standard shipping fee. I hereby release and shall indemnify and hold harmless Heartland Pet Cremation and its successors, assigns, sister, parent, and subsidiary companies and their respective officers, directors, shareholders, employees, and agents from any and all liability, claims, suits and damages arising from or relating to the handling, cremation and release of my pet. I understand and agree that Heartland Pet Cremation’s liability arising under this agreement shall be limited to and shall not exceed the amount paid by me to Heartland Pet Cremation and, further, that Heartland Pet Cremation shall not be responsible for any indirect, incidental, special or consequential damages I may suffer or claim, including without limitations damages for emotional distress. I acknowledge that Heartland Pet Cremation shall not be liable for any loss or delay resulting from any events outside of its control, including without acts of god, fire, national disaster, terrorism, war or labor stoppage. I agree that this authorization from shall be governed by the laws of the state in which services were performed. In the event Heartland Pet Cremation or its representatives have to initiate a collections action against me, I agree to pay the cost of the collection, including attorneys’ fees. "Authorization* I have read the Terms of Service and I give permission to Heartland Pet Cremation to cremate my pet. Authorization Name* First Last CAPTCHA - What is 9 plus six*Please enter a number from 15 to 15.NameThis field is for validation purposes and should be left unchanged.