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 ones details

First name

Middle Name/s

Last name

Known As

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

Did they pass away at this location?

Yes

Where did they pass away? *

We need a little more information about your loved one

What was their highest level of education?

What was their ethnicity?

What was their race?

Occupation (Cannot be retired)

Type of Industry

Social Security Number

Primary Care Physician

We thank your loved one for thier service

If there is anymore information you can give us that could help

Branch

Other Branch

Service No

Rank

Entry to Millitary Date

Discharge from Millitary Date

Your relationship

I'm their *

Other:

Please tick 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

Next of kin details

Please tick 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

Title

Mr Miss Mrs Ms

First name

Last name

Phone number

Email address

Where are they located?

Executor details

Title

Mr Miss Mrs Ms

First name

Last name

Phone number

Email address

Where are they located?

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).

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?

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. But 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

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

Pick Up at Funeral Home Mail - Set Charge Delivery Other

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/s:

Last name:

Known As:

Date of Birth:

Date of Death:

Age (Yrs):

Age (Mths):

Age (Days):

Check all that apply:

Your Address

Where are you located?:

Can we send mail to this address?:

Where is your loved on currently located

Where are they located?:

Did they pass away at this location?:

Where did they pass away?:

Your loved ones details

What was their highest level of education?:

What was their ethnicity?:

What was their race?:

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:

Other::

Please tick all the statements that apply:

Next of kin details

Please tick all the statements that apply:

Title:

First name:

Last name:

Phone number:

Email address:

Where are they located?:

Executor details

Title:

First name:

Last name:

Phone number:

Email address:

Where are they located?:

Packages

Packages:

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?:

Casket Selection

Selected Casket:

Other details you want the Funeral Director to know:

Urn / Jewelry Selection

Selected Urn / Jewelry:

Disposition Details

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

Other:

Delivery To:

Other:

Please make sure all details are correct before submitting