Do you wish to be buried or cremated?

Choose One Burial Cremated

IF BURIAL THEN

Do you own a plot in any cemetery?

Choose One Yes No

If yes, does the plot contain an existing burial?

Choose One Yes No

If no, do you wish to make provision for two interments?

Choose One Yes No

Do you wish your service to be held in

Choose One At our Shone and Shirley Chapel A Church At the Graveside Other Venue

For any special requests, instructions or enquiries, fill out the Special Requests box at the bottom of this form.

IF CREMATION THEN

Which crematorium do you wish to use?

Choose One Nelson

Do you wish your service to be held in

Choose One At our Shone and Shirley Chapel A Church At the Crematorium Other Venue

For any special requests, instructions or enquiries, fill out the Special Requests box at the bottom of this form.

YOUR DETAILS

Name

Street Address

Street Address line 2

Suburb

City

Email Address

Phone Number 

(including Area Code)

Special requests, instructions or enquiries