Pre-Arrangement Form

Who is this plan for?

Full Name (of the person who this is for)*:

What Relationship are you to this Person?*:

Your Full Name*:

Mailing Information

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Email Address*:

Phone Number:

Service Information

In general, what type of services are you seeking?*:

Will there be any viewing (public or private) before the Cremation/Burial?*:

I Prefer the Viewing To Be:*:

Will there be a Funeral, Memorial or Life Celebration?*:

I Prefer the Funeral Service To Be*:

Place of Service:

Disposition Information

I Prefer:

After Cremation: What is the disposition for the cremains?*:

**Unclaimed cremated remains will be returned to the crematorium for disposition.

If Cremation: Do you wish to witness the cremation?*:

If Cremation, Give an Estimated Weight:*:

If Cremation: Does the body contain a pacemaker or any type of a battery implant? *:

Please note: for cremation, pacemakers and similar battery-powered devices must be removed by the funeral director prior to cremation. Your permission will be obtained for this procedure. These devices cause harm to the cremation process.

**Artificial implants such as screws, rods, or heart stents will not effect the cremation.

**Neither do power-ports for chemotherapy or similar drug treatment sites.

Cemetery:

Do you own the burial space that is to be used?*:

Address:

Phone:

Special Instructions

Other Information:

Send Information

Please select one of the options below:

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Simple Choices, Inc.

218 2nd Avenue

Troy, NY 12180

Directions

(518) 435-8030

Simple Choices Cremation Service is proud to be selected by Cremation with Confidence, offering their exclusive guarantee.

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Mailing Information