Plan your own funeral

If you would like to plan your own funeral, you can fill out this form to let us know your wishes. Please complete all the fields then click the print button at the end. You can print and keep a copy for yourself & your next-of-kin.

If you have any questions, please contact us on 01604 79 22 22 – we’re here for you.





Your Name (required)

Your Email (required)

Your Address (required)

Your Phone Number (required)

Your Occupation (required)

Your Martial Status (required)

Your Date of Birth (required)

Your Place of Birth (required)

Next of Kin (required)

Next of Kin Address ( required)

Next of Kin Telephone Number (required)

Your Relation to Next of Kin (required)

Location of Will and other information (required)

Funeral Home (required)

Preference of Cremation or Burial (required)

Music and Hymns

Flowers (required)

Donations in Lieu of Flowers (required)

Charity/Charities

Would you like us to send you some information on pre-paid funeral plans? (required)

Would you like us to contact you to arrange an appointment? (required)

Would you like us to keep you information on file? (required)

Is there any additional information you would like us to know?

You can print a copy of this form for your own records if you wish. Please do this first before clicking the submit button to send the form to us. All data submitted is kept private and confidential.