Personal Information (Step 1 of 7)

Your Personal Information

First Name *

Middle Name

Last Name *

Phone *

Email *

Beneficiary's Personal Information

This Plan is For:

Select

Myself
Parent
Spouse
Relative
Child
Sibling
Friend
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First Name

Middle Name

Last Name

Gender

Male

Female

Birth Place

Birth Date

Family Information (Step 2 of 7)

Marital Status

Married

Single

Widowed

Name of Spouse

Maiden Name of Spouse (if Applicable)

DD/MM/YYYY

DD/MM/YYYY

Father's Name

Address (if Living)

City

State

State Zip/Postal Code

Mother's Name

Maiden Name

Address (if Living)

City

State

Zip/Postal Code

Siblings (Living)

Siblings (Deceased)

Children (Living)

Children (Deceased)

Grandchildren (Living)

Grandchildren (Deceased)

Great Grandchildren (Living)

Great Grandchildren (Deceased)

Education / Work (Step 3 of 7)

Highest Level of Education

School Name

School Location

Occupation

Company

Years at Company

Military Service Details (Step 4 of 7)

Military Service

Yes

No

Branch of Service

Years Served

Service Options (Step 5 of 7)

Visitation Options

Visitation at funeral home

I do not wish to have a visitation

Funeral Options

Funeral service at funeral home

I do not wish to have a funeral service

Reception Options

Reception at funeral home

I do not wish to have a reception

Service Requests (Step 6 of 7)

Please list any musical selections you would like to include in the services:

Please list any poems, religious texts, or readings you would like to be read at the services:

Please list any interests or hobbies you would like to include in the services:

Please list any special themes you would like to include in the services:

Please list any specific foods or beverages you would like to make available to your family and guests at the services:

Final Disposition (Step 7 of 7)

Aquamation, Terramation, Cremation, or Burial:

Aquamation

Terramation

Cremation

Burial

Graveside/Committal Service?

Yes

No

Disposition Options:

Ground Interment (Burial)

Mausoleum Entombment (Above Ground Burial)

Columbarium (for Cremation Urns)

Ashes Returned to Family