Pre-Arrangement Form

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Personal Information

First Name

Last Name

Middle Name

Maiden Name

Address

City

Province/State

Postal Code/ZIP

Telephone Number

Email Address

Occupation

Company Name

Business Field

Date of Birth

Place of Birth

SIN

Marital Status

Parental Information

Father’s Name (First and Last Name)

Mother’s Name (First and Last Name)

Mother's Maiden Name

Father's Place of Birth

Mother's Place of Birth

Spousal Information

First Name

Last Name

Date of Birth

SIN

Middle Name

Maiden Name

Place of Birth

Address (if different)

Date of Marriage

Place of Marriage

If Common-Law, Date of Cohabitation

Additional Family MembersPlease use the area above to enter the names of siblings, children and grandchildren.

Person In Charge of Your Estate

Is the person in charge the executor of your estate?

YesNo

Do you have a will in place?

YesNo

First Name

Middle Name

Last Name

Address

City

Province/State

Postal Code/ZIP

Telephone Number

Email Address

Funeral Service Request

Which location would you like to pre-arrange your funeral?

CasselmanEmbrun

Place of Visitation

Other

Place of Service

Other

Religious Denomination

Place of Worship

Disposition Request

I Prefer

Other

Cemetery

Address

Telephone Number

Lot Number(if applicable)

Section/Letter(if applicable)

Grave Number(if applicable)

Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed just keep my request and information on file

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