Pre-Arrange Online

  • Personal Information

Address

This Form Completed By

Spouse's Information

Spouse's Address

Father & Mother Information
Work
Funeral Service Information
Disposition Information

Is/Are there Executor(s)

More Executors?

Additional Information
Special Instructions

Please list any other instructions or information you would like us to have

Send Information
For Office Use Only

Office Staff Only

Funeral Home Information

Additional Deceased Information
Informant

Do You Require a Second Informant

Do You Require a Third Informant

Additional Disposition Information

Burial Information Required?

Service Type
Physician
Survivor
Survivor
Survivor
Survivor
Visitation Information
GPS Coordinates (Optional)

Do You Require A Second Visitation?

GPS Coordinates (Optional)

Do You Require A Third Visitation?

GPS Coordinates (Optional)
Service Details
GPS Coordinates (Optional)

Do You Require A Second Service?

GPS Coordinates (Optional)

Do You Require A Third Service?

GPS Coordinates (Optional)
Interment Details

Do you Require Interment Details for the Website?

GPS Coordinates (Optional)

Do You Require A Second Interment?

GPS Coordinates (Optional)

Do You Require A Third Interment?

GPS Coordinates (Optional)
Future Services

Future Service Information Required?

Do you want an announcement for the Future Service?

Clergy / Minister
Church Requirements
Charity Selection
Service Clubs
Pallbearer Information

Pallbearers Information Required?

Pallbearer
Pallbearer
Pallbearer
Pallbearer
Pallbearer
CPP - Deceased Information

CPP - Deceased Information Required?

Deceased Different Name at Birth?

Deceased Different Name on Social Insurance Card?

Deceased Live or Work in Another Country?

Add Another Country?

Add Another Country?

Deceased Receive or Apply for a Benefit?

If Yes to Any of the Above, Provide Social Insurance Number

Deceased/Spouse Eligible to Receive Family Allowance/Child Tax Benefit for Any Children Born After December 31, 1958?

CPP - Spouse Information

CPP - Spouse Information Required?

Home Address Same as Mailing Address?

Address

Spouse Different Name at Birth?

Spouse Different Name on Social Insurance Card?

Spouse Receiving or Applied for a Benefit?

If Yes to Any of the Above, Please Provide Social Insurance Number or Account Number Under Which You Applied

Common-Law Information Required?

Under 45 at Time of Spouse's Death?

Child(ren) Information

CPP - Child(ren) Information Required?

Child(ren) Under 18?

Add a Second Child?

Child(ren) Between 18-25 in Post-Secondary?

Address

Add a Second Child?

Address

Child(ren) Receiving or Applied for a Benefit?

If Yes to Any of the Above, Provide Name and Social Insurance Number for Corresponding Benefit

Child 1

Child 2

Child 3

Child 4

Child(ren) In Your Custody Since Spouse's Death?

Descendant Born After December 31st, 1958?

If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada

Add A Second Child?

If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada

Add A Third Child?

If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada

Add A Fourth Child?

If Child Was Born Outside of Canada, Fill-in the Date the Child Entered Canada

Were You The Primary Caregiver For These Children From Birth Until Age 7?

Children Under Age 7 and Did Not Receive Family Allowance

Will Information

Deceased Have a Will?

Purchaser Information

Additional Purchaser Required?

Additional Purchaser Required?

Package Selection

Service Options

Package Options

Goods and Services - Professional Services

Other Services

Goods and Services - Use of Staff and Related Facilities

Supervision Services

Other Staff

Use of Facilities

Other Facilities

Goods and Services - Transportation

Transfer of Remains to Funeral Home

Vehicle Selection

Other Vehicles

Goods and Services - Merchandise

Casket Selection

Other Casket

Vault Selection

Other Vault

Urn Selection

Other Urn

Goods and Services - Stationery

Stationery Options

Goods and Services - Additional Merchandise and Services

Additional Services and Merchandise

Other Merchandise

Goods and Services - Cash Disbursement
Explanation of Charges
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