HOME
OUR SERVICES
MEMORIALS
REQUEST A SERVICE
FUNERAL ETIQUETTE
GALLERY
ABOUT
HOME
OUR SERVICES
MEMORIALS
REQUEST A SERVICE
FUNERAL ETIQUETTE
GALLERY
ABOUT
Service Request FORM
3737
page-template-default,page,page-id-3737,wp-custom-logo,theme-bridge,bridge-core-2.7.5,woocommerce-no-js,give-test-mode,give-page,qode-page-transition-enabled,ajax_fade,page_not_loaded,,qode-title-hidden,side_area_uncovered_from_content,columns-4,qode-theme-ver-26.0,qode-theme-bridge,disabled_footer_bottom,qode_header_in_grid,eael-woo-slider,elementor-default,elementor-kit-7,elementor-page elementor-page-3737
Complete the information below
Please enable JavaScript in your browser to complete this form.
Name
First
Last
Email
*
Phone
*
In what relation are you with the deceased?
Who is the Memorial or Funeral for?
*
First
Last
Nick Name
Multiple Choice
*
Female
Male
Not Applicable
Date of Birth
*
Date of Death
*
Obituary
Upload High Resolution of the deceased person
Click or drag a file to this area to upload.
Will there be a memorial service?
*
Yes
No
If Yes, where will the Memorial Service be held?
Address
Address Line 1
Address Line 2
City
State / Province / Region
When is the Memorial Service?
Date
Time
Memorial Service optional extras
LIVESTREAMING
TWO LCD SCREENS
MULTIPLATFORM STREAMING
ZOOM or TEAMS GUEST
EXTRA MICROPHONE
SLIDESHOW CREATION
WHATSAPP FLYER WITH LINK
PRINTABLE DIGITAL PROGRAM
SANITIZATION STATIONS
Choose extra options for your service
When is the Funeral Service?
*
Date
Time
Funeral livestreaming optional extras
TWO LCD SCREENS
MULTIPLATFORM STREAMING
ZOOM or TEAMS GUEST
EXTRA MICROPHONE
SLIDESHOW CREATION
WHATSAPP FLYER WITH LINK
PRINTABLE DIGITAL PROGRAM
SANITIZATION STATIONS
Choose extra options for your service
Where will the Funeral Service take place?
*
Will there be streaming at graveside?
Yes
No
What time?
Address for Funeral Service
*
Address Line 1
Address Line 2
City
State / Province / Region
Additional instructions for us
Submit
