Heritage Memorial - Advance Planning

There are numerous benefits to pre-planning a cremation, some of which include:

Provides peace of mind
Relieves your loved ones of unnecessary concern
Reflects your expressed wishes
Allieviates financial burden on your family

Please take a few minutes to fill out the Online Pre-planning form below. Once the information is submitted, a Heritage Memorial representative will review and file it and will be in touch with you to further discuss the details of your arrangements.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link, if interested.

IMPORTANT: Use the tab key, or mouse, to navigate. Do not use the enter key for navigation, or it will try to send the form before it is complete.

Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Information about the person completing this form:

I am Planning For:

Last Name: , First Name: Middle:

Street Address:

City: State: Zip:

County: Phone:

E-mail:

Vital Information about the person you are planning for:

Last Name: , First Name: Middle:

Gender: Marital Status:

Social Security #: Date of Birth:

Place of Birth:

Spouse's Full Name:

Spouse's Maiden Name:

Place of Marriage: Date of Marriage:

Mother's Name: Mother's Maiden Name:

Father's Name:

Work and Education

Education (Primary): College:

Usual Occupation (most of life):

Kind of Business: Company:

Military Records

Branch of Service: Serial Number:

Date Enlisted: Rank at Discharge:

Date Discharged: Discharge on file at:

Copy of discharge papers?:

Name of Wars:

Funeral Service Information

Place of Service:

Name of Funeral Home:

Address: Phone:

Place of Visitation:

I prefer the funeral service to be:

Viewing for Family?: Viewing for Friends?:

Religious Denomination:

Place of Worship:

Lodge/Union:

Person(s) to Finalize Arrangements at Time of Death

Check here and skip this section if information is the same as person filling out this form

Full Name:

Street Address:

City: State: Zip:

Phone:

Special Instructions

Flower Preference:

Music:

Casket Bearers
    1:
    2:
    3:
    4:
    5:
    6:

Jewelry:

Glasses:

Clothing:

Other:

Disposition Options

I prefer:

Cemetery:

Address: Phone:

Section:

I have made a last will and testament:

Other Information and Special Instructions

Please list any other instructions or information you would like us to have:

Memorials & Charities

Please list any Memorials or Donations to Charity that you would like:

Contact Options

Send information about pre-arrangement
Contact me to set an appointment
Please keep my information on file

Please click Send (Submit) button only once

You may also use the PDF file below if you prefer to mail the form.

Advance Planning Form

Mail to:
Heritage Memorial - 6705 S.E. 14th Avenue - Portland, OR 97202 (address is also on the form)

NOTE: Adobe Acrobat Reader software is required to view this file. If you do not already have Adobe Reader installed on your computer, it is available for free from Adobe's website - please click here or on the icon at left to be taken to the download page in a separate window.


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