First Name :
Last Name :
Address :
City :
Province :	Alberta British Columbia Manitoba New Brunswick Newfundland N-W-T Nova Scotia Nunavut Ontario P-E-I Quebec Saskatchewan Yukon
Postal Code :
Telephone :
Email :
Do you have a preference between  traditional earth burial and cremation?	Traditional Cremation
Do you own cemetery property?	Yes  / No
If you choose cremation, how would  you like the urn placed? (earth burial, columbarium, cremation garden scattering)
Do you need assistance with  monuments?	Yes  / No
Do you have a religious denomination?	Yes  / No
If yes, what is your denomination?
Are you affiliated with an  organization?
What would be your selection of  music?
In what newspaper would you like  a death notice to appear in?
Out of town newspapers?	Note: We display Death Notices on our website at no charge
Do you have a preference in  flowers?
Do you feel your family would want  to spend time together with you  before burial or cremation to say  their goodbyes? (We do require identification before cremation)	Yes  / No
Do you prefer a chapel or church  service?	Chapel  / Church
Do you have a preference in steel or  wood caskets?
Do you require information on  cremation urns or burial vaults?	Yes  / No
Do you have coverage in case of death out of town, province or country?	Yes  / No
Do you wish to meet with our  prearrangement counsellor to obtain  information on prepayment,  different payment options,  personalized quotation sheets, or  simply to obtain more information?	Yes  / No