THIS AGREEMENT PROVIDES FOR CARE AND MAINTENANCE CEMETERY INTERMENT RIGHTS, MERCHANDISE AND SERVICES PURCHASE/SECURITY AGREEMENT

Date: ____________________ No. ____________________ The undersigned, referred to as “Purchaser”, hereby agrees to purchase the Interment Rights, Merchandise and Services described herein, subject to acceptance and approval of the above named cemetery, hereinafter referred to as the “Seller”. PURCHASER: _______________________________________________ TELEPHONE: (____)__________________

ADDRESS: ___________________________________________________________________________________________ Street City State Zip

Name of Deceased: ________________________________________________________________________________

Description of Interment Rights: ______________________________________________________________________

Issue Certificate of Interment Rights to: _______________________________________________________________

Address: ____________________________________________________________________________________________ Street City State Zip

Interment Rights, Merchandise and Services

Interment Rights (Including Care and Maintenance of $_________)…………………$_____________ Interment Fees…………………………………………………………………………………..$_____________ Outer Burial Container: Model ________________Supplier____________________.......$_____________

TOTAL PURCHASE PRICE………………………………...…$_____________ LESS: Down Payment (Cash/Credit Card/Check)………….$_____________ Other Credit…………………………………………………$_____________ Total Down Payment……………………………………………………..…$< > UNPAID BALANCE OF PURCHASE PRICE…………………………………$_____________

REMARKS:____________________________________________________________________________________________________________________________________________________________________________________

TERMS – SALE AGREEMENT TO PAY. The Total Purchase Price is due and payable as of the date of this Agreement. A delinquency charge of five percent will be assessed monthly on any balance not paid within 30 days of this Agreement. If less then full payment is received, Seller shall deduct the accrued delinquency charge from the amount received, and credit the remained of the payment to the Unpaid Balance.

TITLE. Seller will retain title to said Interment Rights and Merchandise until the Total Purchase Price, together with any delinquency charges thereon have been paid by Purchaser to Seller.

CEMETERY RULES AND REGULATIONS. Purchaser shall comply at all times with all Rules and Regulations and By laws now existing, or hereafter adopted by the Seller and approved by the Florida Department of Banking and Finance, Division of Finance, of the care, control, management and protection of the cemetery, and for all other purposes deemed necessary by Seller for the proper conduct of the business of the cemetery and the protection and safeguarding of the premises, principles, and plains and ideals upon which the cemetery was established. Purchaser understands that such Rules, Regulations and Bylaws are maintained subject to inspection by Purchaser at the office of Seller. ANY QUESTIONS OR COMPLAINTS CONERNING THIS TRANSACTION MAY BE DIRECTED TO THE FLORIDA DEPARTMENT OF BANKING AND FINANCES AT (800) 323-2627. NOTICE: BY SIGNING THIS AGREEMENT, PURCHASER IS AGREEING THAT ANY CLAIM PURCHASER MAY HAVE AGAINS THE SELLER SHALL BE RESOLVED BY ARBITRATION AND PURCHASER IS GIVING UP HIS/HER RIGHT OF APPEAL.

Signed this _____ day of ___________________, 20____

Purchaser: ________________________________________ Accepted By: _____________________________ Relationship

Purchaser: ________________________________________ Counselor: ________________________________ Relationship