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 Arrangement Form.

Welcome to our online prearrangement form. Once this form is filled out and submitted, it will allow us to generate all the necessary documentation for your prearrangement. These documents will come to you fully complete and all you will need to do is print, sign, and fax/scan.

If you feel more comfortable giving this information over the phone, or meeting with a funeral director in person, please contact us at 905-529-2403 as our staff will be ready to assist you.

Purchaser's Information

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

Relationship to Beneficiary
First name
Middle name
Last name
Street Address
City
Zip 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
Zip 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.
Location of Deceased
First name
Middle name
Last name
Birth Information
Date of Birth
City of Birth
State Of Birth
Country Of Birth
Social Security Number

Marital Information
Marital Status	-- Please select -- Single Married Widowed Divorced Common-Law Same-Sex Partner
Spouse Name
Spouse's Middle Name
Spouse's Maiden Name

Armed Forces
Has the person ever served in the armed forces?	Yes No
What branch of service?	-- Please select -- Army Air Force Navy Marines
Do you have a copy of their discharge papers (DD214)?	Yes No

Residence Information
Street Address
City
Zip Code
Father's Name (Last, First)
Father Middle Name
Father Last Name
Mother Name
Mother Middle Name
Mother's Maiden Name (Last, First)
Demographics
Education	-- Please select -- 8th Grade or less 9th - 12th Grade, no diploma High school grad or GED College, no degree Associate Degree Bachelor Degree Master Degree Doctorate Unknown
Hispanic Origin	Yes No -- Please select -- Mexican Cuban Puerto Rican Other
Race (specify if necessary)	-- Please select -- White Black/African American Asian Indian Chinese Filipino Vietnamese Japanese Korean Hawaiian Samoan Guamanian American Indian/Alaskan Native (specify Tribe) Other Asian (specify) Other Pacific Islander (specify) Other (specify)
Occupation Information
Occupation for most of working life
Industry

Services
I would like to prepay I am planning in advance Undecided
Cremation Burial Undecided
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 L-Train Ad Facebook/Social Media	Radio Ad Bus Ad Bus Shelter Ad TV Commercial TV Interview Other
Verification Options	Please verify by phone Please verify by email
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