Funeral Director Name

Funeral Reference

Deceased Name

Date of Funeral

Time of Funeral

Burial Location

Time we will arrive at graveside

Coffin Shape (please refer to above image a, b or c)

Coffin Length (ft/ins)

Coffin Width (ins)

Coffin height (ins)

New / Existing?

Grave Reference (if applicable)

Grave Length (ft/ins)

Grave width (ins)

Grave depth (single/double/triple)

Depth description (if applicable)

Special Instructions (if applicable)

Grave will be marked by (include phone number)

Existing Memorial (please provide details if applicable)

Service will be officiated by

Minister's name and telephone number

Requested by (at funeral directors)

Your Email Address (Mandatory)