Prearrangement Form

The prearrangement form is designed for those who wish to pay for our services in advance. If you would like to pre plan for our services but pay for them at the time of need please fill out our At Need Information Sheet.

This is the information we will need in order to fill out all of the necessary documentation. You may communicate this information to our staff over the phone or if you prefer, you can enter the information below.

If you only have some of the information please fill out as much as you can. The remaining information can be later submitted here or communicated to us over the phone.

Please enter the information of the person filling out this form.

Purchaser's Information

Relationship to Beneficiary
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail

Next of Kin/Executor Information

Is there a will?	Yes No Unsure
In order to make final arrangements we will require the executor's participation and permission.
Is the above person the executor of the will?	Yes No
Is the above person the legal next of kin?	Yes No
Please enter the information of the executor below:		Please enter the information of the legal next of kin below:
Relationship to Beneficiary
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail

Beneficiary's Information

This is the person whom the funeral arrangements are being made for. This person may or may not be the same as the purchaser.

First name
Middle name
Last name
Street Address
City
Postal Code
SIN
Date of Birth
City of Birth, Province
Marital Status	-- Please select -- Single Married Widowed Divorced Common-Law Same-Sex Partner
Spouse's Maiden Name
Occupation for most of working life
Industry
Father's Name (Last, First)
Father's Place of Birth (City, Province)
Mother's Maiden Name (Last, First)
Mother's Place of Birth (City, Province)

Services

I would like to prepay I am planning in advance Undecided
Cremation Burial Undecided
Would you like to purchase an urn?	Yes No
What type of urn would you like?
Do you currently have cemetery property?	Yes No
Please specify which cemetery
Would you like more information, or to have us organize, one of the following services?	I do not wish to organize a service 1 hour family gathering more info A family gathering of up to 25 attendees and held at any of our pre-designated locations with an urn present. Flowers, catering, and other services can be arranged. Memorial Service more info A 2 hour visitation incorporating a brief formal or ritual service if desired with an urn present. Our staff can arrange for everything, including flowers and catering if desired. Visitation more info A 2 hour visitation followed by a service and ceremony. Families also have the option of a graveside service after the ceremony as well as a reception if necessary. Identification more info Being able to see a loved one before a final disposition is helpful for a sense of closure. This is not necessarily a funeral service, but an opportunity to briefly say goodbye before final disposition. Witnessing of Cremation more info Witnessing of a cremation is a service where families wish to witness the actual cremation process. This is a very common request since this type of brief ceremony provides families and friends with a feeling of closure.
Would you like help settling your estate?	Yes No
Are you interested in the World Travel Plan?	Yes No
Are there any additional services you are considering?	Yes No
Please specify
Additional Notes:
How did you find out about our services? (Specify if possible)	Internet Brochure Friend/Family Hospital/Nursing Home Billboard Newspaper Article Subway Ad	Radio Ad Bus Ad Bus Shelter Ad TV Commercial Yellow Pages Other
Verification Options	Please verify by phone Please verify by email
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