Arrange Now Owner InformationName* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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? Home Vet's office Other Address 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 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 Do you want the ashes returned? Yes No Additional 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 specifically agree that if the said cremated remains are left in the custody of Heartland Pet Cremation for over thirty (30) days, Heartland Pet Cremation will be authorized to dispose of the cremated remains in a dignified manner. 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 CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
