Pre-Arrange (Self)

Your Information

Your Full Legal Name*

Also Known As

If you are referred to or known by another name, please specify. Example: Legal name is Robert Smith but referred as Bob Smith.

Your Address

Street Address City Province Postal Code

Your Email*

Enter Email Confirm Email

Your Phone #

Your Birth Month

Your Birth Day

Your Birth Year

Your Place of Birth

City State / Province / Region Country

Marital Information

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 Your Spouse Share The Same Address As You?*

Spouses Address

Street Address City Province Postal Code

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

Work Status

Your Occupation

Examples: 'Construction' or 'Bookkeeper' or 'Salesperson'

Your Current or Past Employer

Affiliations

Please list any groups or organizations you are affiliated with.

Military Information

Were You In The Military?

Branch of Service

Do You Have A Copy Of Your Discharge Papers?*

Your Military Service Number (DVA#)

Funeral Service Information

Preferred Location of Service

Where would you like your service to be held?

Location Specific

Name of the church, cemetery or other location.

I Prefer My Funeral Service To Be

Viewing For Family

Viewing For Friends

My Religious Denomination

Example: Catholic, Jewish, Atheist or None.

My Place of Worship

My Lodge or Union

Disposition Information

I Prefer

Cremation Options

Do You Have A Preferred Cemetery?*

Address

Cemetery Name City Province Phone Number

Do You Have An Executor?

Do you have a will and testament with a named Executor?

Name of Executor

First Last

Executor Relationship

Executor Address

Street Address City Province Postal Code

Executor Email

Executor Phone

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 your preferred Pallbearers.

Special Instructions

Do You Plan On Pre-Paying For Your Funeral?

There are many benefits to pre-paying for you funeral including: - Ease the burden on your family. - You want your 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 your 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 your funeral service that you'd like us to honor.

Your Social Insurance Number (SIN) will be required and collected over the phone.