Order Your Pet Cremation Package

Will you be bringing your pet to La Paloma Pet or would you like us to pick up your loved one?*
- Please pick up (fee may apply)
- I will bring my pet during business hours to La Paloma Pet Cremation
Business hours are 8:30am – 5pm Monday through Friday
Where is pet located?*
- Home - $65
- Vet
Name of Vet*
Vet Phone*
Address for pickup*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Do you want your pet's remains returned?*
- Yes
- No
Return to Veterinarian?
What is your pet's approximate weight?*
Your pet will be weighed.
What is your pet's approximate weight?*
Your pet will be weighed.
Your Name*
First Last
Phone*
Date*
Date Format: MM slash DD slash YYYY
Name of Pet*
Pet Name
Breed*
Pet Gender*

Please select a package
All packages include individual cremation.
Package*
- Tin Package - $105 + tax
- Wood Box Package - $120 + tax
- Photo Box package - $140 + tax
- Vase Package - $160 + tax
- Witness and Wait Package - $300 + tax
Wood Choice*
- Oak
- Cherry
Engraving

Please Choose a Keepsake
Paw Print Keepsake
Paw Print Keepsake - $25 + tax
Price: $27.10 Quantity:
Acrylic Paw Print Keepsake
Acrylic Paw Print Keepsake - $50 + tax
Price: $54.19 Quantity:
Ceramic Paw Print Keepsake
Ceramic Paw Print Keepsake - Blue - $50 + tax
Price: $54.19 Quantity:
Ceramic Paw Print Keepsake - Black - $50 + tax
Price: $54.19 Quantity:
Ceramic Paw Print Keepsake - Brown - $50 + tax
Price: $54.19 Quantity:
Ceramic Paw Print Keepsake - Pink - $50 + tax
Price: $54.19 Quantity:
Acrylic Vial Keepsake

Each purchased vial will be filled with your pets' remains at no charge.
Acrylic Vial - Option A - $35 + tax
Price: $37.93 Quantity:
Acrylic Vial - Option B - $35 + tax
Price: $37.93 Quantity:
Acrylic Vial - Option C - $35 + tax
Price: $37.93 Quantity:
Acrylic Vial - Option D - $35 + tax
Price: $37.93 Quantity:
Acrylic Vial - Option E - $35 + tax
Price: $37.93 Quantity:
Acrylic Vial - Option F - $35 + tax
Price: $37.93 Quantity:

1. Cremation Authorization: The owner hereby authorizes La Paloma Pet Cremation to cremate the remains of the pet listed above. In providing this authorization, the undersigned represents that he or she is the Owner or Legal Representative of the Owner and has the full right and authority to arrange the cremation and the disposition of the cremated remains of the above-named Pet.

2. Cremation Process: The undersigned acknowledges that due to the nature of the cremation process, any material on the remains of the Pet, such as collars, tags, etc., will be destroyed if not removed. Accordingly, the undersigned has removed any such material or, if the material is present on the Pet's remains, the undersigned understands it will either be destroyed or removed and disposed of by La Paloma Pet Cremation.

3. Disposition of Cremated Remains: The undersigned directs La Paloma Pet Cremation to take the following actions with regard to the cremated remains of the above-listed Pet. If not picked up within fourteen (14) days of the date of death, La Paloma Pet Cremation may dispose of the cremated remains in any lawful manner or if storage is requested, a storage fee of $10 per month will apply after the initial fourteen (14) days.

4. Certification: The undersigned certifies the accuracy of all the information on this Authorization and will indemnify and hold harmless La Paloma Pet Cremation, their owners, employees and agents, from any liability, cost, expenses or claims resulting from the Authorization and release thereon.

BY SUBMITTING THIS FORM YOU UNDERSTAND THAT THE CHARGE FOR ALL THE ABOVE SHALL BE PAID IN FULL PRIOR TO COMPLETION OF SERVICES.
YOUR Full Name (Electronic Signature):*
First Last
To receive a copy of this form you must fill in your email address*
Enter Email Confirm Email

Please be sure to check your spam/junk folder.
Did you order a keepsake?*
After this submission has been received you will be unable to purchase any additional keepsakes.
- No, but I would like to.
- Yes, I did.
- No, I don't want one.
Please hit the previous button below to return to the keepsakes page and make your selection.

Review Order, then click NEXT to proceed to checkout.
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Email*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Please enter first name followed by today's date.*
**Please only hit send once, do not hit the back button, and do not refresh this page. Doing so can result in duplicate charges to your card.**

**Favor de solo presionar “Submit” una sola vez, no presione el boton que dice “Back” y no refresque esta página. Si hace esto, puede resultar en cargos duplicados a su tarjeta.**

Please select a package

Please Choose a Keepsake

Paw Print Keepsake

Acrylic Paw Print Keepsake

Ceramic Paw Print Keepsake

Acrylic Vial Keepsake

Review Order, then click NEXT to proceed to checkout.