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As a Trusted Advisor, my goal is to help you understand the process and put your final wishes in writing. With rising costs, it is important to know what the requirements are to prevent overspending. This service is at no cost to you.

Your candid answers to these questions will greatly assist you in pre-planning your services. To show my gratitude, I will give you a FREE Funeral and Cremation planning guide to help you get started. This handy guide helps to make your final wishes known.

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

Spouse

Children

Other family

At some point I would like to take care of it ahead of time

* In your opinion, what would be the biggest benefit(s) of planning your own funeral in advance?

Knowing your family will not have to make decisions at an emotionally difficult time

Eliminating the possibility of a financial burden to your family

Protecting your assets from Nursing Home costs, and help qualify for Medicaid

* Would it give you peace of mind to know your funeral is planned and monies set aside in advance, thereby relieving your family of this burden?

Yes

No

* Did you know that each cemetery has different requirements?

Yes

No

* Which of the following advantages of pre-planning are most important to you?

Preventing disagreements between family members

Ensuring your family does not overspend

Pre-Payment

Knowing your wishes will be carried out

* Are you aware that The Funeral Lady has various programs with payment plans available that allow you to prepay funeral costs?

Yes

No

* Which of the following free information can we provide to you?

Funeral planning options and cost comparisons

Burial prices

Cremation prices

Social Security death benefits

Veterans benefits

* Name

First

Last

* Address

Street Address

Address Line 2

City

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State

ZIP Code

* Phone

* Email

What is your age (ages)

Any additional information or questions?