Fillable Inmancliente App

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Inmancliente App

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  • 46 other fields

Country of origin: OTHERS
File type: PDF

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FUNERAL
CREMATION
Participant:________________________________________________________________________
Current Legal Address:_____________________________________________________________________________________
City:_________________________________County:___________________________State:______Zip Code:_______________
Date of Birth: ____/_____/_____ Sex:_____Social Security #: _____-_____-_____ Home Phone #: (_____) _______________
Marketer:_____________________________________________ID#:_________________________
Funeral Home/Company:_____________________________________________________________
Address:_________________________________________________________________________________________________
City:_________________________________County:___________________________State:______Zip Code:_______________
Phone#: (______)_________________________________________________________________________________________
Membership Benefits include
Contacting a licensed funeral home or professional embalming service center near the place of death
Transporting the deceased from the place of death to the funeral home or service center for preparation
Preparation of the deceased for transport
Securing all documentation for shipping including one death certificate
Placing the deceased in appropriate shipping container
Tender to the airport for return to the airport closest to their legal residence that is capable of receiving human
remains including airfare
In the event of death of a Participant who is 100 miles or more away from his or her legal residence at the time of death, the Travel Plan by
Inman will render every assistance, including locating a local, licensed funeral home, mortuary or direct disposition facility, arranging and
paying for the transportation of the body from the site of death to the licensed funeral transport, purchasing the minimally necessary casket
or air tray for transportation, arranging for the transportation of the remains to an airport capable of receiving human remains which is
closest to the deceased’s legal residence and securing all documentation including one death certificate.
Return of remains services are provided by Inman Shipping Worldwide when Participants are traveling 100 miles or more from their legal
residence* or in another country which is not the country of residence. All services MUST be arranged by Inman Shipping Worldwide, NO
claims for reimbursement will be accepted. Enrollment in the Travel Plan by Inman is not valid until payment has been received by the Travel
Plan Administrative Center and an enrollment number has been issued to the purchaser.
*Legal residence is defined as the permanent fixed place of abode. Legal residence will require verification through voter registration, driver’s
registration, and/or other means. A nursing home will be deemed the residence if the stay there has exceeded 180 days.
If Participant enrolls in the Travel Plan while Participant is away from his or her legal residence, the plan of assistance will not become
effective until the Participant has returned to his or her legal residence for subsequent travel.
Return to:
Travel Plan by Inman
9077 Stellhorn Crossing Parkway
Fort Wayne, IN 46815
____Check enclosed, payable to Travel Plan by Inman.
___________________________________________________ ____________________________________________________
Participant’s Signature Marketer’s Signature
02/18
Participant will be mailed their membership identification
card and change of address from the Travel Plan by Inman.
Questions: (888) 889-8508
You may also sign up online at:
www.shipinman.com
Travel Plan Participant (s)
Member 1: Date of birth:
Payment Options ($450 single, $425 for 2
nd
plan at same address) TOTAL $_____________
1. Check made payable to the Travel Plan by Inman submitted with Participation Agreement
to: Travel Plan by Inman
9077 Stellhorn Crossing Parkway
Fort Wayne, IN 46815
2. Credit card payment option: ___VISA ___MASTERCARD ___AMEX EXP ___DISCOVER
Credit card number: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp. Date _ _ /_ _ Security Code _ _ _ _
Participant’s Signature Printed Name Date
Marketer’s Signature______________________________Printed Name____________________________________
Marketer ID:_____________________________________
Note: Upon completion of credit card transaction, this form will be shredded for participant’s protection.
Phone: Email Address:
Address: City:
State: Zip: Gender: Male Female
Member 2: Date of birth:
Phone: Email Address:
Address: City:
State: Zip: Gender: Male Female
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Inmancliente App

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Completed 26 July 2020

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