Would you like a Burial or Cremation?
Burial
Cremation
Both (for example, cremation and burial of ashes)
Neither / Something else
Not Sure Yet
Which services would you like to include?
Viewing / Showing – a chance for loved ones to see the body
Memorial Service – typically a more somber, reflective, quiet experience
Celebration of Life – more grateful, relaxed, natural environment
Viewing / Showing Location
Funeral Home
My Home
Church
Graveside
Park / Hall / Ballroom
Other (specify)
Not Sure
Memorial Service Location
Funeral Home
My Home
Church
Graveside
Park / Hall / Ballroom
Other (specify)
Not Sure
Celebration of Life Service Location
Funeral Home
My Home
Church
Graveside
Park / Hall / Ballroom
Other (specify)
Not Sure
Where should we send your basic outline?
Send My Basic Plan
Would you like to continue with more Advanced Planning?
Select…
Yes
No
Legal Name
Sex
Select…
Male
Female
Other
Social Security Number
Date of Birth
Place of Birth
Street Address
City
County
State
Ever in U.S. Armed Forces?
Select…
Yes
No
Level of Education
Hispanic Origin
Select…
Yes
No
Race
Father’s Legal Name
Mother’s Name (Prior to Marriage)
Executor’s Name
Executor’s Relationship
Executor Mailing Address / Phone
Would you like your plan to reflect any spiritual or cultural traditions?
Select…
Yes (write below)
No
Prefer not to say
Describe your spiritual/cultural traditions
Would you like a prayer service?
Select…
Yes
No
Not sure
Do you currently own a cemetery plot?
Select…
Yes
No
Not Sure
Does it include a vault?
Select…
Yes
No
Not sure
Opening/Closing of the grave included?
Select…
Yes
No
Not Sure
Do you have special circumstances for transportation of the body?
Select…
No special circumstances
Family-only transport
Hearse Required
Long-distance transfer
Not sure
Describe any special transportation needs
Do you have Life Insurance to help with your final plans?
Select…
Yes
No
Not Sure
Policy #1
Add Another Policy?
Select…
Yes
No
Policy #2
Add Another Policy?
Select…
Yes
No
Policy #3
Add Another Policy?
Select…
Yes
No
Policy #4
Add Another Policy?
Select…
Yes
No
Additional Policy Information
Song Selections
Would you like to see if you qualify for additional funding options?
Select…
Yes
No
Not Sure
Do you have any health conditions?
Select…
No major medical conditions
Minor conditions
Significant health history
Prefer not to say
Which budget range best fits your plan?
Select…
Less than $4,000
$4,000 - $7,000
$7,000 - $12,000
$12,000 - $15,000
$15,000+
Not sure
Finish & Submit
