Arrangement And Or Pre-Arrangement Form

Spouse's or Next of Kin Information

Spouse's or Next of Kin Name:

Spouse's Maiden Name:

Spouse's or Next of Kin Address

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Father & Mother Information

Father's Name:

Father's Place of Birth:

Mother's Name:

Mother's Maiden Name:

Mother's Place of Birth:

Work

Your Occupation:

Kind of Business:

Company Name::

Military Information

Branch of Service:

Select One Royal Canadian Navy Canadian Army Royal Canadian Air Force

Serial Number:

Date Enlisted:

Funeral Service Information

Place of Service:

Select One Funeral Home Church Cemetery None

I Prefer the Funeral Service to be:

 Public

 Private

Viewing for Family:

 Yes

 No

Viewing for Friends:

 Yes

 No

Religious Denomination:

Place of Worship:

Disposition Information

I Prefer:

Select One Burial Cremation Entombment Aquamation

What to do with My Ashes:

Select One Burial Scatter Take them Home

Cemetery:

I Have Made A Last Will & Testament:

 Yes

 No

Additional Information

Flower Preference:

Music Selections:

Casket Pallbearers:

Jewelery:

Glasses:

Clothing:

Special Instructions

Other Information:

Memorials & Charities:

Send Information

Please Select One of the Options Below:

Select One Send More Information About Pre-Need Contact to Set an Appointment Please keep my information on file Send Above Info to Funeral Home