Pre-Arrange Funerals

Funeral & Cremation Burial Pre-Arangements 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: Select Marital Status ---------------------------- Married Divorced Widowed Never Married 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: (Please Select) Angelus Rosedale Rose Hills Green Hills Forest Lawn Inglewood Park Other 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:   (Please Select) U.S. Army U.S. Navy U.S. Air Force U.S. Marines U.S. Coast Guard Other 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) 316-1373