First Name (Requester)
Relationship to Decedent
I declair that have legal authorization to request ash scattering services and hold CSBS harmless from action, lawsuit and all litigation if this statement is untrue.
Yes, I assume all liability and hold CSBS harmless.
No (By selecting this option, CSBS will decline services).
Sea Scattering Services (Unattended)
I elect to have CSBS provide private Sea Scattering Services. I authorize and release the ashes to CSBS for this service at the convenience of CSBS
Sea Scattering Options
Off of the Coast of Broward or Palm Beach County ($95) Provided quarterly
Off of the Florida Keys ($295) Provided 2 Times per year.
Certificate of Location
1 @ no charge
Additional copy ($5.00 each)
Ash Delivery Options
We will mail ashes to CSBS - Must use priority express and request signature
We will deliver ashes to CSBS
CSBS is requested to pick up ashes in Palm Beach or Broward County (add $50)
If Mailing Ashes
Ashes must be mailed to 2855 NW 25th Ter., Boca Raton, FL 33434 with a requested signature.
Name of Decedent
Local Sea Scattering $95.
Sea Scattering Florida Keys $295.
Name on Card
Credit Card Type
Credit Card Number
Expiration Date (mm/yy)
By signing this form, I hereby understand that ash scattering is permanent and irreversible. I also agree to any charges for cancellation, mailing or returning of ashes due to cancellation or other charges for services added to or requested on my behalf.