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Home
Pricing
Cremation Forms
Urns and Jewelry
Obituaries
About Us
Location
Questions

Pre-Need Form - Use this form prior to someone passing.

Use this form to provide us with as much information as you can regarding the person who the pre-arrangement is for. All of the questions asked are used for legal forms such as the death certificate. (Any questions not answered will be left blank on the final death certificate.)

Pre-Arrangement Client Information

Personal Information

Full Name of person who the pre-arrangements are for. (First, Middle Initial, Last)

Street

City

State/Province

ZIP/Postcode

Date of Birth

Social Security Number

Place of Birth (City/Town, State)

Marital Status

Spouse's Name

Spouse's Maiden Name

Father's Name (If Known)

Mother's Name (If Known)

Mother's Maiden Name (If Known)

Self Described Race

WhiteAfrican AmericanOther

Of Hispanic Origin?

NoHispanicPuerto RicanMexicanOtherUnknown

Work/Education History

Education Level

Grade-School

High-School

Some College

Associate's Degree

Bachelor's Degree

Masters-Degree

Doctorate

Occupation (Job title for most of working career) Do Not use Retired

Company Name (Company worked for longest)

Business Field (Manufacturing, Service, etc.)

Military Service

Military Service?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Do you have a copy of the discharge papers? (If so, Please provide us with it)

YesNo

Family Member in Charge of this Cremation

Name of Person Legally in charge of Cremation Arrangements

Your relationship to person these pre-arrangements are for

Street address of “Person in Charge”

City / State / Zip

Person in Charge Telephone and Email Address

How may Certified Copies of the Death Certificate do you need? The State charges $ 20. per copy.

Please ask any questions you may have.

Price for Services we provide. (Please check all that apply to you.)

$ 1,495. Direct Cremation with in Berks County.

$ 95. Additional charge for Transfer of Deceased from outside of 20 miles radius of our office, plus a $2.50 per mile charge over 20 miles.

$ 395. Additional charge for Private Family Viewing, 30 minutes, 10 people Maximum.

$ 95. Mailing of Cremated Remains anywhere in the USA.

$ 195. Memorial Package: Guest Register Book, 100 Memorial Folders or Thank you cards and envelopes

$ 195. Scattering of Cremains at Sea. Must complete authorization under Cremation Forms.

Use of our Standard Square White Polystyrene Urn. All Cremated Remains are placed into this type of container unless another is selected.

Use Urn and/or Cremation Jewelry you selected above.

$ 95. Placement of Cremains into your pre-purchased urn.

Any Deceased that weighs over 250 lbs. will be charged and additional $ 395. for the cremation process.

Payment Options for Pre-paying a Cremation Service.

Cash

Check

Credit Card or Debit Card: A 3.75% fee will be added to the total for all pre arrangements paid via credit/debt card. This fee is imposed upon us by the credit card company.

* Click on the “Monthly Payment Program" tab on the home page for monthly payment options. *

Click on the Submit Button Below when finished.

By submission of your information to us you are requesting that a Funeral Director contact you with the intent of pre paying for these cremation arrangements Please visit the Pricing tab above for a complete understanding of cost associated with this Pre arrangement

Mark A. McCarter, Supervisor