1. How old are you?

Under 25 26-35 36-54 55-65 66-75 76 or older

2. Do you have children? Yes No

3. Have you been responsible for making funeral arrangements for someone else?

Yes No

4. Which of the following would you choose for yourself?

Burial Cremation Mausoleum Not Sure

5. How much would you expect your funeral to cost?

$2,000-$3,999 $4,000-$5,999 $6,000-$8,500 Over $8,500

6. In the event of your death, who is responsible for making your final arrangements?

Spouse Children Other family member Other

7. Does this person know your preferences including cremation, burial, type of casket, music, flowers etc.? Yes No

8. Do you have updated biographical information and accurate records to help this person with your funeral planning? Yes No

9. Are you concerned about "emotional overspending" by the person planning your funeral if the decisions are left to be made at an emotional time? Yes No

10. Who is responsible for paying for your final arrangements?

Spouse Children Other Family Other

11. Do you have a prepaid funeral plan? Yes No

12. Would it give you peace of mind to know you've planned and paid for your final arrangements? Yes No

Thank You

As a thank you for your time, would you be interested in receiving a complimentary Memories Book where you can record your personal memories, information about funeral planning, prices and types of services that are available?

Yes No

If you are interested, please provide your name and phone number below and a Preneed Counselor will contact you with more information.

Name

Phone

Email