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WE OWN AND OPERATE OUR OWN IN-HOUSE, PRIVATE CREMATORY
Your Loved One Does NOT Leave Our Care
CALL US: 1-800-CREMATE

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:*
Your 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 Country
Full Legal Name (including maiden) of person to be buried:*
First Middle Last Maiden
Address*
City State / Province / Region ZIP / Postal Code Country
Inside City Limits?*
- Yes
- No
- Not Sure
Phone Number:*
Place of Birth

City, State or Country
Date of Birth*
MM slash DD slash YYYY
Sex:*
- Male
- Female
Marital Status*
- Married
- Divorced
- Widowed
- Never Married
Race*

White, Black, Asian, Native American, Other
Of Hispanic Descent:*
Social Security Number*

XXX-XX-XXXX
Father's Name*

FIRST, MIDDLE (not required), LAST
Mother's Name:*

FIRST, MIDDLE (not required), LAST, MAIDEN
Mother's Maiden Name :*
Highest Level of Education Completed*
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:*
Branch of Service:
Ever Served as a TX Peace Officer:*
- Yes
- No
Informant's Legal Name:*

FIRST, MIDDLE (not required), LAST
Informant'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:
Untitled
Additional Death Certificates:*
Name(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?*
Email
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