FORM PART 2 of 2 Thank you. Now please provide us with some important information about your loved one: Name of your loved one * First Name Last Name Middle Name Middle Name Maiden Name (if applicable) Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Sex * Male Female Place of Birth: * City, Province, Country Marital Status * Married Never Married Widowed Divorced Common Law Legally Separated Name and Maiden Name of Spouse (if applicable) Social Insurance Number Occupation * If or when the deceased was working (Prior to retirement) Do they have a Will? * Yes No Unsure Their father's name and place of birth (if known) Their mother's (maiden) name and place of birth (if known) Where is your loved one now? * Hospital or Hospice Private Residence Coroner's Office Other Please provide the name of the facility or address * Date of Death Do they have a pacemaker or a radioactive implant? * Yes No Unsure Lastly, please select your preferred package * Please note that payment is not required in advance and can be made through Credit Card, Debit, Cheque, Cash or e-transfer according to your preference at the time of delivery. Simple Cremation $2,000 Cremation and Urn $2,175Laminate Urn (Natural) Cremation and Urn $2,175 Laminate Urn (Cherry) Direct / Natural Bural $2, 190 Eden 100 Eco Casket Thank you for providing this important information. We will begin preparing the necessary documentation and will contact you shortly to confirm next steps for bringing your loved one into our care. We are also available 24 hours a day at 519 767 2221 should you need immediate assistance.
