Your responses are extremely important to us.Please answer the following questions and return this survey to our office.Thank you for your assistance.Have you ever been responsible for making Funeral or Cremation arrangements? yesnoIn the event of your death, who would be responsible for making the arrangements?SpouseOtherChildrenWould you like current information on Social Security & Veterans Burial Benefits? yesnoMay we show you how a pre-arranged funeral/cremation plan may protect some of your assets from long term care costs?yesnoWould you like to know how your final expenses can be honored and completely paid for, regardless of inflation?yesnoWould you like to learn more about:Burial OptionsOptions for VeteransCremation OptionsI’m most interested in learning more about:Giving peace of mind to myself and family knowing my plan is in placeGuarantee that my family will never have to pay more for my final expensesProtecting assets from MedicaidPayment options for my preplanned funeralWould you like current information on Urns, Markers and/or Monuments?yesnoWould you like to learn more about the emotional & financial benefits of advanced funeral/cremation planning?Absolutely. I’ve been through the distress of planning a funeral at the last minute and I don’t wish that burden on anyone.Yes. It’s not something I’m eager to do, but I know it’s the right thing to do for my family.Maybe. I’ve heard a little bit about the financial benefits and how it would benefit my family.I’m not sure. I don’t really understand advance planning or why I should consider this option.I have already. If you have already pre- planned with us, we thank you.No, thank you. I don’t want to think about it and I’ll let my family take care of it.To receive your free My Planning Guide™ Please provide your:Name: First Last Age:Souse: First Last Spouse Age:Address: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryPhone: Area Code - Phone Number Best Time:MorningAfternoonEveningWeekendE-mail:SubmitReset
