Cremation Wizard – Lorem Funerals

Your Details

Title

Mr Miss Mrs Ms

First name

Last name

Phone number

Email address

How would you like us to contact you?

Phone Email SMS

Your Loved One's Details

First name

Middle name

Last name

Known As (other than legal name)

Date of Birth

Date of Death

Age (Yrs)

Age (Mths)

Age (Days)

Check all that apply

They were a veteran

They have a pacemaker

Your Address

Can we send mail to this address?

Yes

Where is your loved one currently located?

We will arrange to bring them into our care.

Please check all the statements that apply

They passed away at this address

They lived at this address

We need a little more information about your loved one

What was their highest level of education?

What was their race?

Hispanic

Yes No

Occupation (Cannot be retired)

Type of Industry

Social Security Number

Primary Care Physician

We thank your loved one for their service

Please provide more information.

Branch

Other Branch

Service No

Rank

Entry to Millitary Date

Discharge from Millitary Date

Your Relationship

I'm their *

What is your place of birth?

Other:

Please check all the statements that apply

I am the next of kin

I am the executor of their will

I am the person you will send the invoice/account to

I will receive the death certifcate

Your Loved One's Parents

Please give us a bit more information about Your Loved One's parents

Mother - First Name

Mother - Middle name

Mother - Last Name

Suffix

Place of Birth

Life status

Living Deceased

Father - First Name

Father - Middle name

Father - Last Name

Suffix

Place of Birth

Life status

Living Deceased

Next of Kin Details

Please check all the statements that apply.

Next of kin is the executor of the will

Next of kin is the person you will send the invoice/account to

Next of kin will receive the death certifcate

Relationship to Loved One *

Title

Mr Miss Mrs Ms

First name

Last name

Phone number

Email address

Address

Executor Details

Relationship to Loved One *

Title

Mr Miss Mrs Ms

First name

Last name

Phone number

Email address

Address

Packages

Our charge for a direct cremation (without ceremony) or any attendant rites or ceremonies includes: basic services of funeral director and staff, a proportionate share of overhead costs, local removal of remains and transportation to crematory. If you want to arrange a direct cremation, you can use an alternative container. Alternative containers encase the body and can be made of materials like fiberboards or composition materials (with or without an outside covering). The alternative containers we use are wood and fiberboard.

*The state required medical examiner fee ($200) and crematory/cremation fee ($425).

Casket Selection

Select a casket

Your loved one will be placed in an alternative container (a casket is not needed for direct-cremation) as required by the crematory. Should you wish to upgrade this container to one of the below cremation-friendly alternatives we would be honored to do so.

Other details you want the Funeral Director to know

Urn / Jewelry Selection

Select an Urn

Your loved ones cremains will be returned to you by our staff in a minimum container provided by the cemetery, or you have the option to upgrade to an urn from our selection below.

Post Cremation

Do you require a copy of the death certificate? A cost of $15 applies for each copy.

Yes

Number of copies of the death certificate required?

After the cremation has taken place, how would you like to receive the ashes?

Pick Up at Funeral Home

Mail - Set Charge

Delivery

Other

Delivery To

Caller

Other

Cremation

Your Details

Title:

First name:

Last name:

Phone number:

Email address:

How would you like us to contact you?:

Your loved ones details

First name:

Middle name:

Last name:

Known As (other than legal name):

Date of Birth:

Date of Death:

Age (Yrs):

Age (Mths):

Age (Days):

Check all that apply:

Your loved ones birth details

City:

State:

Country:

Your Address

Where are you located?:

Can we send mail to this address?:

Where is your loved on currently located

Where are they located?:

Please check all the statements that apply:

Where did your loved one pass away

Your Loved One's Address Details

Your loved ones details

What was their highest level of education?:

What was their race?:

Hispanic:

Occupation (Cannot be retired):

Type of Industry:

Social Security Number:

Primary Care Physician:

Veteran details

Branch:

Other Branch:

Service No:

Rank:

Entry to Millitary Date:

Discharge from Millitary Date:

Your relationship

I'm their:

What is your place of birth?:

Other::

Please check all the statements that apply:

Your loved ones parents

Mother - First Name:

Mother - Middle name:

Mother - Last Name:

Suffix:

Place of Birth:

Life status:

Father - First Name:

Father - Middle name:

Father - Last Name:

Suffix:

Place of Birth:

Life status:

Next of kin details

Please check all the statements that apply.:

Relationship to Loved One:

Title:

First name:

Last name:

Phone number:

Email address:

Address:

Executor details

Relationship to Loved One:

Title:

First name:

Last name:

Phone number:

Email address:

Address:

Packages

Packages:

Casket Selection

Selected Casket:

Other details you want the Funeral Director to know:

Urn / Jewelry Selection

Selected Urn / Jewelry:

Disposition Details

Do you require a copy of the death certificate? A cost of $15 applies for each copy.:

Number of copies of the death certificate required?:

After the cremation has taken place, how would you like to receive the ashes?:

Other:

Delivery To:

Other:

Please make sure all details are correct before submitting

Cremation

Your Details

Your Loved One's Details

Your Loved One's Birth Details

Please provide the location of where your loved one was born.

Your Address

Where is your loved one currently located?

We will arrange to bring them into our care.

Your Loved One's Place of Passing

Please provide the address of where your loved one passed away?

Your Loved One's Last Residential Address

Please provide the address of the last place Your Loved One lived at.

We need a little more information about your loved one

We thank your loved one for their service

Please provide more information.

Your Relationship

Your Loved One's Parents

Please give us a bit more information about Your Loved One's parents

Next of Kin Details

Executor Details

Packages

Casket Selection

Select a casket

Your loved one will be placed in an alternative container (a casket is not needed for direct-cremation) as required by the crematory. Should you wish to upgrade this container to one of the below cremation-friendly alternatives we would be honored to do so.

Urn / Jewelry Selection

Select an Urn

Your loved ones cremains will be returned to you by our staff in a minimum container provided by the cemetery, or you have the option to upgrade to an urn from our selection below.

Post Cremation

Cremation

Your Details

Your loved ones details

Your loved ones birth details

Your Address

Where is your loved on currently located

Where did your loved one pass away

Your Loved One's Address Details

Your loved ones details

Veteran details

Your relationship

Your loved ones parents

Next of kin details

Executor details

Packages

Casket Selection

Urn / Jewelry Selection

Disposition Details