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Cremation Authorization

RADIANT HEART AFTER-CARE FOR PETS (Life Cycle Pet Cremation, Inc. dba)

801 W. Orchard Drive, Suite 3, Bellingham, WA 98225

360-778-9578 * info@radiant-heart.net

Owner/Agent:

Phone:

Email:

Regular Vet: Fairhaven Veterinary Hospital

Pet's Name:

Gender:

Weight:

Age:

Type:

Breed/Description:

Cremated Remains Returned:

Type of Cremation Requested:

After-Care Package Requested:

Type of Ink Print if After-Care Package Requested:

Urn Type:

Radiant Heart May Contact Me to Confirm Order and Collect Payment:

Credit Card Payment (No Contact Requested): CC Number- Expiration- CVC- Billing Zip Code-

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

September 10, 2020 12:58 pm PDT

Cremation Authorization Uploaded by Michael Bellis - info@fairhavenvet.com IP 173.10.102.169