Pre-Arrange (On Behalf)

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.