Please use this form to get started on pre-planning or arranging a service of your choice. If you would prefer to speak with us directly, or if you have any questions, please do not hesitate to call us at 519-351-4444 or Toll-Free 888-297-3575 Name of person the arrangements are being made for* First Middle Last Maiden Name (if applicable)Date of Birth* DD MM YYYY Place of Birth*Social Insurance # (Optional)Email Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Type of work done most of working life*Marital Status* Married Single Divorced Widowed Common-law Spouse's Name (if applicable) First Middle Last Date of Marriage - If ApplicableFather's Name First Middle Last Father's Place of BirthMother's Name (with Maiden name) First Middle Last Mother's Place of BirthMy Wishes & Obituary DetailsIf Choosing Full BurialName of CemeteryIf Choosing Cremation Ashes Stones If Choosing Full Body DonationDesired Medical School Is there a Will* Yes No Please select one of the following... Please send me information Please contact me to schedule an appointment Purchasers InformationPlease enter the information of the person filling out this formName* First Last Maiden Name - If ApplicablePhone*Email Date of Birth DD MM YYYY Place of BirthRelationship to Recipient*Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Would you like to organize any of the following services: Home Funeral Memorial Service Visitation and Reception Brief Final Viewing Witnessing of Cremation Please select one of the following... Please send me information Please contact me to schedule an appointment
