10200 - 17th Street
DAWSON CREEK, BC V1G 4C2
Phone: 250-782-2577 or 1-800-577-4877
Fax: 250-782-1264

Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will help expedite the funeral arrangement process.

I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
Province:
Postal Code:
Telephone Number:

(xxx-xxx-xxxx)

Email Address:
Date of Birth: (month/day/year)
City of Birth:
Province of Birth:
 
   
Social Insurance Number: For security reasons, we will contact you to complete the pre-arrangement.
 
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Time of Military Service:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information

Please contact me to schedule an appointment

Please place my information on file