Preneed Survey

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?

yes

In the event of your death, who would be responsible for making the arrangements?

Spouse

Other

Children

Would you like current information on Social Security & Veterans Burial Benefits?

yes

May we show you how a pre-arranged funeral/cremation plan may protect some of your assets from long term care costs?

yes

Would you like to know how your final expenses can be honored and completely paid for, regardless of inflation?

yes

Would you like to learn more about:

Burial Options

Options for Veterans

Cremation Options

I’m most interested in learning more about:

Giving peace of mind to myself and family knowing my plan is in place

Guarantee that my family will never have to pay more for my final expenses

Protecting assets from Medicaid

Payment options for my preplanned funeral

Would you like current information on Urns, Markers and/or Monuments?

yes

Would 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 CodeCountry

Phone:

Area Code

Phone Number

Best Time:

Morning

Afternoon

Evening

Weekend

E-mail: