Your Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Thank you. Now, please provide some information about your loved one: (the person these services are for). Note - if pre-arranging for yourself, you may skip this section and proceed to "Date of Birth"

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Sex *

Male

Female

Is there a Will? *

Yes

No

Unsure

Does this person have a pacemaker or radioactive implant? *

Yes

No

Unsure

Reason for pre-arrangements *

Death is imminent (days)

Death is imminent (weeks / months)

Long term planning

Please select your preferred package *

Simple Cremation $2,000

Cremation and Urn $2,175 - Rosewood Urn - Classic

Cremation and Urn $2,175- Laminate Urn (Cherry)

Cremation and Urn $2,175 - Laminate Urn (Natural)

Direct / Natural Burial $2,190 - Eden 100 Natural Casket