Pre-Arrangements Form

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Pre-Arrangement Details

Personal Information

Full Legal NameAs it appears on your birth certificate

Street

City

State/Province

ZIP/Postcode

Date of Birth

Place of BirthCity and Province (if outside of Canada, state the country)

SIN

Telephone (Home)

Telephone (Cell)

Email Address

Father's Full Legal Name

Father's Place of BirthCity and Province (if outside of Canada, state the Country)

Mother's Full Legal Name

Mother's Maiden Name

Mother's Place of BirthCity and Province (if outside of Canada, state the Country)

Marital Status

Date of Marriage

Spouse's Name

Spouse's Maiden Name

Additional Family MembersPlease use the area above to enter the names of children, grandchildren, siblings or other individuals that might be listed in an obituary.

Occupation

Business Field

I have made a last will and testament

YesNo

Location of Will

Executor or Next-of-Kin Responsible for Decisions

Address

Telephone

Email Address

Funeral Service Request

Chapel Location

Preference for Disposition

Cemetery

Grave Location

Lodge/Union/Assoc. MembershipThese details assist with personalizing services and obituary

Summary Details

Additional Instructions

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed, just keep my request and information on file

Updating my existing pre-arrangement information on file

Anti-Spam Security Question

Funeral Directors Since 1860 Serving Our Communities with Honesty, Integrity & Fair Prices

Low & Low Limited Chapel Locations:

Uxbridge Chapel
Licensed Funeral Establishment
Operator Class 1 - License No. 530
23 Main Street South, PO Box 388,
Uxbridge, Ontario L9P 1M8

To View our 'Information & Price Guide'

Please click the download link to the left. Please reach out to ourselves should you require any further explanations. To receive an accurate and complete quote, without obligation, please contact our staff directly. We would be happy to assist you and your family.

Port Perry Chapel
Licensed Funeral Establishment
Operator Class 1 - License No. 605
1763 Reach Street, PO Box 698,
Port Perry, Ontario L9L 1A6

Licensed by the Bereavement Authority of Ontario (BAO)

The BAO’s Consumer Information Guide: A Guide to Death Care in Ontario is a free consumer-protection information booklet. The guide is written for families and the public to know their rights and responsibilities before entering into contracts with organizations that are licensed under the Funeral, Burial and Cremation Services Act, 2002

To view the guide please click HERE