How may we assist you?*

Please choose a package*

Deceased Information

Please provide us with the following information about the deceased. We will need this information in order to complete the death certificate and move forward with the cremation process.

General Cremation Information

Name*

First Middle Last

Maiden Last Name (if applicable)

Sex*

Date of Birth*

Date of Passing

Age*

Location Information

Location of Your Loved One's Place of Passing (Please enter as much information as you know.)

Address*

Street Address City State ZIP Code

Confirm loved one's address

The location where my loved one is currently is also their home address

Home Address*

Street Address City State ZIP Code

Place of Birth:*

City State County

Personal Information

Personal Information needed for the Death Certificate

Social Security Number

Name as Listed on Social Security Card (If Known)

First Middle Last

Highest Education Attained*

Race [ex, White, African/American, Asian]*

Ancestry (Countries of Origin)*

Hispanic Origin (Yes or No)*

Military Service (Yes or No)*

What was their job title?*

In what type of business?*

Marital Status*

Spouse's Name at Birth (Only if Married)

First Middle Last

Father's Name*

First Middle Last

Mother's Name at Birth*

First Middle Last

Informant Section

Informant Information

The informant is the person providing us with the information about the deceased.

Informant's Name*

First Middle Last

(This is the person providing the information, whose name and address will also appear on the death certificate.)

Relationship to Loved One*

Informant's Address*

Street Address City State ZIP Code

Informant's Phone*

Informant's Email*

Important Notes

Please provide any important information that would be helpful in your planning. Example: Is your loved one being cared for at home or in hospice? What is the best contact number for the primary caregiver?

Cremation Price Section

Cremation Payment Options

Your total for service is: $950

Your total for service is: $1850

Payment Option

Payment will be taken at the time of passing

Would you like to pay now?*

I would like to pay online.
I would like to pay over the phone or in person.

Call 616.288.9610

616.288.9610

Full Cremation Form - No Pre Planning

Deceased Information

General Cremation Information

Location Information

Personal Information

Informant Section

Informant Information

Cremation Price Section

Cremation Payment Options

Your total for service is: $950

Your total for service is: $1850

Payment Option