Online Burial Arrangement Form This information is sacred to us. We won't ever sell or abuse it. Should you not know the answer to a question, simply type in "will call" or if cannot find the answer, type "unknown".All of this data MUST be answered on the legal document and cannot be left blank.Name* First Last Email* Phone*I am Planning For:*Choose OneMy ParentMy SpouseMy SiblingMy ChildMy FriendOtherYour Relationship to the person you are planning for*Spouse, Child, Sibling, Friend, Companion, Etc.Your Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Full Legal Name (including maiden) of person to be buried:* First Middle Last Maiden Address* City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Inside City Limits?* Yes No Not Sure Phone Number:*Place of BirthCity, State or CountryDate of Birth* MM slash DD slash YYYY Sex:* Male Female Marital Status* Married Divorced Widowed Never Married Race*White, Black, Asian, Native American, OtherOf Hispanic Descent:*Choose OneNoMexicanPuerto RicanSpaniardOtherSocial Security Number*XXX-XX-XXXXFather's Name*FIRST, MIDDLE (not required), LASTMother's Name:*FIRST, MIDDLE (not required), LAST, MAIDENMother's Maiden Name :*Highest Level of Education Completed*Choose One8th Grade or Less9th thru 12th (No Diploma)High School Graduate or GEDSome College but No DegreeAssociates DegreeBachelor's DegreeMaster's DegreeDoctorate (Phd, EdD) or Professional Degree (MD, DDS, JD)Occupation:*The type of work one primarily did within a particular industry. Example: Homemaker, Teacher, Nurse, Loan Officer, Electrician, etc.Kind of Business or Industry*The type of industry one was involved in primarily throughout their life. Example: Domestic (Household), Education, Healthcare, Construction, Banking, etc.Ever Served in U.S. Military:*Choose OneYesNoUnknownBranch of Service:Ever Served as a TX Peace Officer:* Yes No Informant's Legal Name:*FIRST, MIDDLE (not required), LASTInformant's Email Address/Fax Number:Informant's Phone Number:Informant's Address: City State / Province ZIP / Postal Code Informant's Relation to Decedent:*How Did You Hear About Us* Google Yahoo/Bing Other Internet Facebook Newspaper Hospital Hospice Funeral Home Other Referral Survivors:Preceded in Death by:Additional Information:Funeral Service to be:* Public Private Permission to Embalm Body (required for viewing):* Yes - for Viewing No - for No Viewing Select a Funeral Plan:* Package 1 Package 2 Package 3 Select a Casket:* Minimum Included Upgrade to Good Upgrade to Better Upgrade to Best Clothing & Underclothing:* Yes - We will Bring No - None Provided, No Viewing Hair/Cosmetic Instructions (for PLAN #1 ONLY):Name of Minister & Contact Information:UntitledAdditional Death Certificates:*Choose OneNo ThanksJust the two Included; No extraOne extra +$16.00Two extra +$32.00Three extra +$48.00Four extra +$64.00Five extra +$80.00Six extra +$96.00Seven extra +$112.00Eight extra +$128.00Nine extra +$144.00Ten extra +$160.00Name(s) of Newspaper(s) (include City) for Obituary Placement:Tell us your plan for Casket Flowers:Who Will Submit the Obituary: Family will send Obituary (and Photo) to Funeral Home Family will send Obituary (NO Photo) to Funeral Home Family will submit Obituary to Newspaper No Obituary publicized Name of Cemetery:Cemetery Contact Information (Name, City, State, Zip Code, Phone Numbers):Is Cemetery Property Paid For:* Yes - We Paid Personally No, but will pay it ourselves No, Add it to our Funeral Bill Is Opening/Closing Paid For? If not, We need grave digger information:Is the Cemetery Endowment Fee (if any) Paid:Is a Vault/Liner Required by Cemetery: YES - Required by Cemetery NO, NOT REQUIRED- but I will purchase one NO - No Thanks What about a headstone?* Yes, I'm Interested in purchasing a headstone No Thanks Are you interested in discussing pre-planning for youself or someone else, sometime soon (but after these services are completed?*EmailThis field is for validation purposes and should be left unchanged. Δ