511 S. Franklin Street – Greenville, MI 48838 Office: (616) 754-5638 Fax: (616) 754-0900
On Behalf of a Grateful Nation
Statewide Toll-Free: 1-877-838-6424
3627 Linden Avenue S.E. – Grand Rapids, MI 49548 Office: (616) 452-3006 Fax: (616) 452-3166
Statewide Toll-Free: 1-877-273-6281
www.ChristiansenCares.com
Christiansen Cremation & Funeral Care and Michigan Cremation & Funeral Care are both proud to be locally owned and operated by the Christiansen family. Robert Christiansen, President & Founder
www.MichiganCremation.com
CREDIT CARD AUTHORIZATION I,
, hereby authorize
CHECK ONE:
☐Michigan Cremation & Funeral Care or ☐Christiansen Cremation & Funeral Care
its’ owners, agents, and/or affiliate partners to process the following credit card: ___ Visa
___ MasterCard
___ Discover
(Sorry, we do not accept American Express)
CARD NUMBER 3 DIGIT SECURITY CODE (On Back of Card) EXPIRATION DATE PHONE NUMBER NAME OF CARD HOLDER BILLING ADDRESS ZIP CODE This card is to be used for the following: Services for: Please Note: A 2% convenience fee will be added to the entire contract total if payment is by credit card.
Signature
Date
PLEASE RETURN COMPLETED FORM ALONG WITH PHOTO COPY OF THE CREDIT CARD (FRONT & BACK) TO OUR OFFICES.