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Pre-Arrange Funerals


Funeral & Cremation Burial Pre-Arangement
s


Provide emotional and financial protection for your family,by participating in our Burial Pre-arrangement Plan. By doing so, you freeze the cost of your burial.

We offer pre-arranged funeral and cremation burial services
throughout California .

To learn more about burial pre-arrangement, fill out our online form

or call

(310) 316-1373

1. Your Information:
*First Name:
*Last Name:
*Address
Line 1:
Address
Line 2:
*City: *State:
*Zip Code:
Home Phone: Work Phone:
Cell: Pager:
*E-Mail:

*2. Who is this Pre-Arrangement for?
Myself Spouse
Brother
Other
Father Mother
   Sister

3. Personal Information for whom funeral is being planned:
First Name:

Middle Name:

No Middle Name

Last Name:

Nickname:
Other Name:
Maiden Name (if female):
Gender:
Male: Female:
Address
Line 1:
Address
Line 2:
City:

State:

Zip Code:

County:

Inside City Limits?
Yes No
Home Phone:

Work Phone:

E-Mail:

Social Security Number:

Date of Birth:

City and State of Birth:

Marital Status:
The Pre-Arranged Spouse's Name:

The Pre-Arranged Spouse's
Maiden Name (if Female):

If Spouse is Deceased: Date of Death
Father's First Name:

If you don't know, please type "Unknown"

Father's Middle Name:


Father's Last Name:
<------If you don't know, please type "Unknown"
Living     Deceased
Mother's First Name:

If you don't know, please type "Unknown"

Mother's Middle Name:

Mother's Maiden Name:
<------ If you don't know, please type "Unknown"
Living     Deceased
Kind of Business worked in:

Occupation:

Immediate Family: Please enter information below:
Children (Please list City/State of Residence):
Brothers/Sisters (Please list City/State of Residence):
Grandchildren (Please list City/State of Residence):
Great Grandchildren (Please list City/State of Residence):
Other significant family or friends (Please list City/State of Residence):
Member of a Church: If "Yes", which one?
4. Additional Information Needed:
Please place obituary in the following newspapers:
Daily Breeze Los Angeles Times Press Telegram
Other Newspapers:
You may print my age in an obituary:
Yes No

I would like to write my own obituary:

Yes No Later
Preferred Clergy:

Please engage a Minister to officiate:

Methodist
Priest
Baptist

Rabbi
Other
Social Activities, Memberships, Hobbies:
Memorial Contributions to:
Flowers may be sent to funeral: Yes
No (will not be accepted)
Donations preferred (flowers accepted)
Preferences:
Graveside Serivce Church Service Mortuary Chapel
Non-traditional or other request
Please explain:
5. Cemetery Information:
(Note: Which cemetery do your wish to have your burial in. )
Cemetery Preference:
Other (Please list cemetery, city and state):
 
I already own cemetery plots:
Yes No
I Don't Know

If Yes, which section:

I need help with cemetery plots:
Yes No

Do you own a graveliner or vault?:

Yes No
I Don't Know
Other Special Requests:
6. Additional Preferences:
Veteran of US Armed Forces?:
Yes No
If Yes, please select branch:
 
Do you want:
US Flag (if Veteran)? Military Honors
Choose a casket NOW Choose a casket LATER
Will you need help with a grave marker/
monument?:
Yes
No
Let's Discuss Later

Will a passenger limousine
(for family) be helpful ?:

Yes
No
Let's Discuss Later
Death Certificates:

Certified death certificates are needed for the following:
Social Security (if spouse is living); real estate, automobile, or anything you transfer title to (even if joint ownership); life insurance policy; accounts exclusivley in the deceased name; probate a will; stocks and bonds

My estimate of the number of certified death certificates is:

 
7. Communication with a Cemetery or Funeral Consultant:
I would like to discuss pre-payment (discount offered):  Yes No
E-mail estimated cost to:
Call me to set up an appointment: (We can meet anywhere you wish)

I will contact you when I am ready:

Burial Pre-arrangements


Provide emotional and financial protection for your family, by participating in our Burial Pre-arrangement Plan. By doing so, you freeze the cost of your burial. We offer pre-arranged burial services throughout California .

To learn more about burial pre-arrangement,
call

(310) 350-4290

 


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or
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