Pre-Arrangement Form

Your Information

Full Name*:

Address*:

City*:

Province*:

Postal Code*:

Phone Number*:

Email Address*:

Date of Birth*:

City of Birth*:

Province of Birth*:

Social Insurance Number*:

Spouse's Information

Spouse's Full Name*:

Spouse's Maiden Name*:

Father & Mother's Information

Father's Full Name*:

Father's Place of Birth*:

Mother's Full Name*:

Mother's Maiden Name*:

Mother's Place of Birth*:

Occupation

Occupation held during most of life*:

Type of Business or Industry*:

Funeral Service Information

Place of Service:

I Prefer the Funeral Service to be:

Viewing for Family:

Yes

Viewing for Friends:

Yes

Religous Denomination:

Disposition Information

I Prefer:*:

Cemetery Name:

I have made a Last Will & Testament:

Yes

Location of Last Will & Testament:

Additional Information

Flower Preference:

Music Selections:

Pallbearers:

Please list names for Pallbearers

Jewelry:

Glasses:

Clothing:

Special Instructions

Other Information:

Please add any other information about your wishes in this area

Memorials & Charities:

Please list a charity(ies) that you would like memorial contributions to be placed in your memory

Send Information

Please Select:

Please send me information on funeral planning

Please contact me to schedule an appointment

Please place my information on file

Please wait

5101 - 50 Street
Lloydminster, Alberta T9V 0M2

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Pre-Arrangement Form

Step 1

About Us | Contact Us | Grief Resources | Funeral Planning