FCA of L.I./NYC - Fee Schedule Of Least Expensive Funeral Arrangements Form

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FEE SCHEDULE OF LEAST EXPENSIVE FUNERAL ARRANGEMENTS FROM MAR., 2012 THRU FEB., 2013

Funeral Home Information:
Name
Address
City	State Zip Phone
Website
Are you already a cooperating funeral home of ours? Yes No
Contact Information:
Name of Funeral Home Representative
E-mail Address
Do you prefer FCA LI/NYC to contact you by email? Yes No

Funeral Cost Information:

PLAN I	IMMEDIATE CREMATION Removal from local hospital. Securing necessary authorization and permits. Alternative container. Conveyance to crematory. Includes crematory charge.	$
PLAN II	CREMATION WITH VIEWING Removal from local hospital. Securing necessary authorization and permits. Preparation of body for viewing. Cloth covered fiberboard casket. Use of funeral home chapel for one day. Conveyance to crematory. Includes crematory charge	$
PLAN III	IMMEDIATE BURIAL Removal from local hospital. Securing necessary authorization and permits. Alternative container. Conveyance to local cemetery. Excludes cemetery charges.	$
PLAN IV	BURIAL AFTER VIEWING Removal from local hospital. Securing necessary authorization and permits. Preparation of body for viewing. Cloth covered casket. Use of funeral home chapel for one day. Conveyance to local cemetery. Excludes cemetery charges.	$
PLAN V	JEWISH BURIAL Removal from local hospital. Securing necessary authorization and permits. Plain wood casket without metal. Use of funeral home chapel for pre-burial service. Conveyance to local cemetery. Excludes cemetery charges. See letters G and H below for additional costs of Taharah and Sh'mirah.	$
A. If death should occur prior to a weekend or holiday necessitating delay in burial, the additional charge for refrigeration is $ or for embalming is $
B. Use of funeral home chapel for later memorial service, only under PLAN I and PLAN III, there will be an additional charge of $
C. The word "local" means within a radius from the funeral home of miles
D. Price per mile beyond "local" radius will be additional $ /mile
E. Do you give our members discounts? Yes No If yes, the price includes a discount of approximately Plan I %, Plan II %, Plan III %, Plan IV %, Plan V %
F. Family in attendance at graveside, only under Plan III. If graveside service is held, clergy honoraria and additional cemetery fees are excluded $
G. Taharah – the traditional washing, purification and dressing of the body in white takhrikhim (burial garments).Only under Plan V. $
H. Sh’mirah – the traditional vigil over the dead. Only under Plan V. $
Are you owned by SCI or Alderwoods or other large conglomerate? Yes No If yes, which one?
Are you oriented towards a particular faith? Yes No If yes, which one?
Please send a copy of your General Price List for our files
additional information none

Note: If you are NOT already a cooperating funeral home of FCA L.I./NYC. By submitting this form, you are applying to become a cooperating funeral home of FCA L.I./NYC. Upon receipt of this application, FCA L.I./NYC will determine the suitability of the applicant for our members, including checking with the Bureau of Funeral Directing. If the applicant meets our criteria, the application will then be submitted to the Board of Directors for review and possible approval. The applicant will then be notified of The Board's decision.

FCA L.I./NYC reserves The Right of Refusal for any applicant that it deems unsuitable for its members.