Online Planning Form | Milwaukee Cremation

Information about the person completing this form

Name*

Prefix First Middle Last Suffix

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

I am planning for:*

Other (Please Specify)*

County the person you are preplanning for lives in?*

We service the following counties: Milwaukee, Waukesha, Washington, Ozaukee

Would you like to prepay?*

No
Yes

Selecting "yes" means that you consent to being contacted by our preplanner via email and entering into a formal preplanning contract with us. At that time payment will be put into the form of an insurance policy that our preplanner will set up on your behalf. This insurance policy must be active for at least 30 days before the passing. Please do not select "yes" if you or your loved one are currently or about to be placed on hospice. If you select "no" then our preplanner will not be contacting you and the information provided will be kept on file until time of passing.

Information about the person you are planning for:

All the following Information is used to generate death certificates in the state of Wisconsin.

Name*

Prefix First Middle Last Suffix

Maiden Name

Sex

Date of Birth*

State of Birth

*If the person your are planning for was not born in the United States, please select the bottom option, "Not born in the US"

Marital Status*

Spouse's Full Name*

Prefix First Middle Last Suffix

Spouse's Maiden Name

Father's Name*

First Middle Last Suffix

Mother's Name*

First Middle Last Suffix

Mother's Maiden Name*

Race

Work and Education

Education

Usual Occupation

Please note: "Retired" cannot be entered on the death certificates as a valid occupation. Please enter either the longest held or most favored occupation.

Industry of Occupation

Is This Person of Hispanic Origin

No
Yes (Specify)

Specify Hispanic Origin

Person(s) to Finalize Arrangements at Time of Death

Name*

Prefix First Middle Last Suffix

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

This field is for validation purposes and should be left unchanged.