Pre-Planning Form - Byers Funeral Home

Pre Planning Form

We are here to support you with your pre-planning. Please fill out the form below to indicate your wishes that we will discuss further in an appointment together upon receiving.

Name

Name*
First Middle Current Surname

Address

Address*
Street Address Address Line 2 City Province Postal Code Country

* We are a Canadian company located on South Mountain, Ontario, Canada and do not operate in the U.S.

Contact Information

Email*
Phone*

Personal Details

Marital Status:*
- Single
- Common Law
- Married
- Widowed
- Divorced
Name of Spouse or Partner
First Middle Last
Occupation (when working)*

Parents information

Mother's Name*
Mother's First Name Mother's Maiden Name
Mother's Birthplace*
Father's Name*
First Last
Father's Birthplace*

My Funeral & Burial Wishes

I wish my funeral to be:*
- Public
- Private
I wish for my services to be held at:*
My preference for burial arrangements and other instructions:*
My church affiliation is:
I would prefer as clergyman:
Please list any other instructions or remarks:

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