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

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

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.

Your Information