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Pre-Arrangement Form
Your Information
Full Name
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Address
Address
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City
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Country
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State/Province
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Zip/Postal code
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Email Address
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Phone Number:
Date of Birth:
City of Birth:
Birth Province:
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AB
BC
MB
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NL
NS
ON
PE
QC
SK
NT
NU
YT
Spouse's Information
Spouse's Name:
Spouse's Maiden Name:
Spouse's Address
Address:
City:
Country:
State/Province:
Zip/Postal code:
Father & Mother Information
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's Maiden Name:
Mother's City of Residence:
Work & Education
Education:
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College
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Your Occupation:
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Company Name::
Military Information
Branch of Service:
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Royal Canadian Navy
Canadian Army
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Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge on File at:
Copy of Discharge Papers:
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Funeral Service Information
Place of Service:
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Funeral Home
Church
Cemetery
I Prefer the Funeral Service to be:
Public
Private
Viewing for Family:
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Viewing for Friends:
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Religious Denomination:
Place of Worship:
Lodge or Union:
Disposition Information
I Prefer:
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Burial
Cremation
Entombment
Cemetery:
Address:
Phone:
I Have Made A Last Will & Testament:
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No
Additional Information
Flower Preference:
Music Selections:
Casket Pallbearers:
Jewelery:
Glasses:
Clothing:
Special Instructions
Other Information:
Memorials & Charities:
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