Pre-Arrange (On Behalf) - Essentials Funeral Services

Your Contact Information
Your Name
Please provide us with your own name and contact information. Information about the person you are arranging for will be collected on the next pages.
First Last
Your Address
Street Address City State / Province / Region ZIP / Postal Code
Your Email*
Enter Email Confirm Email
Your Phone #
Relationship*
Please provide your relationship to the person you are making arrangements for. Example: Daughter, Spouse, Friend ...etc.

Arrangement Information
Before you continue:
Please note, all remaining questions pertain to the person you are making arrangements for.
Full Legal Name*
Also Known As
If referred to or known by another name, please specify. Example: Legal name is Robert Smith but referred as Bob Smith.
Address
Street Address City State / Province / Region ZIP / Postal Code
Email
Enter Email Confirm Email
Phone #
Birth Month
Birth Day
Birth Year
Place of Birth
City State / Province / Region Country

Marital Information
Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Current Marital Status
Spouses Name
First Last
Spouses Maiden Name
Spouses Birth Month
Spouses Birth Day
Spouses Birth Year
Spouses Place of Birth
City State / Province / Region Country
Marriage Month
Marriage Day
Marriage Year
Place of Marriage
City State / Province / Region Country
Does Spouse Share The Same Address?*
Spouses Address
Street Address City Province Postal Code

Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Father and Mother Information
Please complete Father and Mother information for parents alive and deceased.
Father's Name
First Last
Father's Place of Birth
City State / Province / Region Country
Mother's Name
First Last
Mother's Maiden Name
Mother's Place of Birth
City State / Province / Region Country

Work & Affiliations Information
Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Work Status
Occupation
Examples: 'Construction' or 'Bookkeeper' or 'Salesperson'
Current or Past Employer
Affiliations
Please list any groups or organizations or affiliations.

Military Information
Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Was or Is The Military?
Branch of Service
Do You Have A Copy Of Discharge Papers?*
Military Service Number (DVA#)

Funeral Service Information
Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Preferred Location of Service
Where would you like the service to be held?
Location Specific
Name of the church, cemetery or other location.
Preferrred Funeral Service
Viewing For Family
Viewing For Friends
Religious Denomination
Example: Catholic, Jewish, Atheist or None.
Place of Worship
Lodge or Union

Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Disposition Information
Type of Disposition
Cremation Options
Preferred Cemetery?*
Cemetary Information
Cemetery Name City Province Phone Number
Executor?
Is there a last will and testament with a named Executor?
Name of Executor
First Last
Executor Relationship
Executor Address
Street Address City State / Province / Region ZIP / Postal Code
Executor Email
Executor Phone

Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Additional Information
Charity and Memorial Donations
Please list the charity or charities you'd like donations to be made to.
Hobbies & Pastimes
Flower Preference
Example: Roses, Tulips or None
Music Selections
Example: Fly by Celine Dion or None
Jewelry
Example: Wedding Ring or None
Clothing
Example: White Dress or Blue Suit
Pacemaker
Casket Pallbearers
Please list the names of preferred Pallbearers.

Before you continue:
Please note, all questions pertain to the person you are making arrangements for.
Special Instructions
Pre-Paying For Your Funeral?
There are many benefits to pre-paying for a funeral including: - Ease the burden on the family. - Final wishes honored. - Cost savings as you are paying for services now that will be more expensive in the future.
Contact Preference
Once you submit funeral details to us, an Essentials team member will contact you on the next business day to confirm your submission and answer any questions you may have. How do you prefer to be contacted? If you have selected email and do not hear from us on the next business day, please be sure to check your spam or junk email.
Other Information
Please describe any other details about funeral service that you'd like us to honor.
Social Insurance Number (SIN) will be required and collected over the phone.
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Your Contact Information