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507 Frederick St., Kitchener, ON N2B 2A5
Phone: 519-749-8467

Online Pre-Arrangement Form

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral service a personal tribute in keeping with the way you wanted.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion at a time when emotional stress may make decisions difficult.

Would it be better in your situation to plan ahead, calmly and sensibly, when you have full ability to reason, and when you are able to discuss arrangements with your family?

You may file vital statistics and preferred funeral information with us on-line by filling in the form below.

I. Biographical Information
Full Name:
Address1:
Address2:
City Name:
Province:
Postal Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
Country of Birth:
Province of Birth:
Social Insurance Number: For security reasons, we will contact you to complete the pre-arrangement.
Father's Name:
Father's Place of Birth:
Mother's Name:
Mother's Place of Birth:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded You In Death
Your Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:
II. Service Preferences
Type of Service:
Visitation Type:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:
         

Miscellaneous Notes and Instructions:

             

Thank you for taking the time to Pre-Arrange.
A Funeral Director will be in contact with you to discuss the details.

Sincerely, 
The Henry Walser Funeral Home

       

 

 

 

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507 Frederick St. | Kitchener, ON N2B 2A5 | Fax: 519-749-8174 | Email: henry@walser.ca