The Horizon Interment Services Registration Form See Our Services Thank you for connecting with us. We will respond to you shortly. 11https://thisinterment.com/wp-content/plugins/nex-formsfalsehttps://thisinterment.com/wp-admin/admin-ajax.phphttps://thisinterment.com/registrationyes1fadeInfadeOut *Name*Address*Phone Number Alt. Phone Number*Email*Date*Age*Marital Status--- Select ---Married SingleOther*Name of the Deceased*GenderMaleFemale*Address*Date of Death*Relation to the Deceased*Cause of Death*How long have you known the deceased?*Religion*Name of Employer*Do you require a Death Certificate?YesNoFuneral Arrangements*Funeral Home of your choice:*What type of funeral service do you require for the deceased?ChurchBurialCremationIs there a particular church you recommend the funeral be held?What arrangements do you recommened?It should include: Programme, flowers, leaflets, caterers, etc.Burial Arrangements*Do you have a burial plot?Yes NoWhere do you recommend the burial take place?Cremation Arrangements*Any specific cremation site?Yes NoDon't KnowIf Yes, Where do you recommend the cremation take place?Do you recommend the cremation be held alongside the funeral service?Yes NoAny specific requirements from the deceased or client for funeral, burial, or cremation?Any additional/Special Request by the deceased or the client?Payment Information*Package of choicePlease note that prices may varyBronze: $1000.00Silver: $1500.00Gold: $2250.00Platinum $4500.00Additional Services RequiredPlease note that prices may varyPrinted material for Funeral/Wakes/Memorials $500TTDFloral Arrangements $200TTDObituaries $500TTDPreparation of Grief Sites $500TTDFuneral Services $1000TTDOrganizing Memorials $1000TTDOrganizing Wakes $1000TTDGeneral and Bereavement Counseling $500TTDPurchase of Paraphernalia (Caskets/Coffins Consultation) $300TTDPastor/Priest/Imam Services $1000TTDFuneral Service Décor and Preparation $500TTDCatering Services $1000TTDAcquiring Venue for Services $500TTDMourners Transport $500TTDOrganizing Headstones, Signs, Foundations and Cornerstones $500TTD*Method of Payment Arrangement50% Down-payment is required on commencementCashCardCheque*Bank of choiceSCOTIA BANK ACCOUNT NO: A0000000031010JMMB ACCOUNT NO: 007700019852By signing this form, I acknowledge and accept the terms outlined by The Horizon Interment Services Limited. THE HORIZON INTERMENT SERVICES LIMITED does not accept any responsibility for allowing an interment that might be the subject of a later dispute between family members, Executors and/or assigns.*I declare that the information provided is true and correct:The family have appointed me as the applicant for the above mentioned interment. The above mentioned information in this information form, to the best of my knowledge, is true and correct.*Date*SignatureSubmitPowered by NEX-Forms Get in touch with us. Contact Email thisintermentservice123@yahoo.com Phone 1-868-741-0350 Follow Designed +Developed by Gifttedco Our Services Registration Form
