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AFFORDABLE ONLINE DIRECT CREMATION

ABOUT
OBITUARIES
SERVICES

PLAN AHEAD
GRIEF SUPPORT
RESOURCES

Planning Ahead

Online Preplanning Form

Free Text

Required Personal Information

Full Legal Name

Date of Birth

Gender

Physical Adress

City

State

Zip Code

Township (If Applicable)

County

Your Email Address

Your Phone Number

Place of Birth (City, State, and County)

Social Security Number

Last Year of Education Completed (HS Graduate, College Degree, etc.)

Race

Ancestry (Up to 5)

Free Text

Work History

Usual Occupation

Kind of Business or Industry

Veteran Status

Yes

No

Branch

Service Number

Free Text

Click Here to Upload a Copy of a Discharge Document If Possible

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Family Information

Marital Status

Spouse's Name

Spouse's Maiden Name (If Applicable)

Place of Marriage

Date of Marriage

Father

Mother (maiden)

Free Text

Informant Information

Name of the Informant

Relation to the Deceased

Phone

Email

Address

PO Box (If Applicable)

City and State

Zip

Free Text

Legal Next Again (If Different From Informant)

Name

Address

PO Box (If Applicable)

City and State

Zip

Phone

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Your Wishes

Method of Final Disposal:

Burial

Cremation

Medical Donation

Please List any Final Disposition

Ground Interment (Burial)

Mausoleum Entombment (Above Ground Burial)

Columbarium (For Cremation Urns)

Ashes Returned to Family

Would You Prefer to Include a Graveside Committal Service?

Yes

No

Funeral Service Option

Funeral Service at Home

Funeral Service Elsewhere

No Funeral Service

Visitation Options

Visitation at Funeral Home

Visitation Elsewhere

No Visitation

Reception Options

Reception at Funeral Home

Reception Elsewhere

No Reception

Free Text

Additional Information for Obituary and Newspaper Notices

Cemetery Information If Applicable (If you own cemetery property, please include lot, section, grave numbers)

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Family Members (please be as specific as you would like and be sure to include names, relationships, and city/state of residence):

Name(s)

Relation

Residence

Name(s)

New Field:

Residence

Name(s)

Relation

Name(s)

New Field:

Name(s)

Residence

New Field:

Relation

Residence

New Field:

Memorial Contributions Should be Made to:

Newspapers (Including City & State) in Which You Would Like Obituary Information Printed)

In the Space Below, Please Indicate Any Special Instructions About the Type & Place of Services, Minister & Other Participants or any Other Information That May be Helpful:

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