Intake form

Help us serve you better

Name *

Email address *

What type of service are you interested in?

Please select at least one option.

Traditional burial

Cremation

Pre-need planning

Grief counseling

What date do you need the services?

What is the deceased's full name?

What is the deceased's date of birth?

What is the deceased's date of passing?

What is your relationship to the deceased?

Please provide the deceased's address.

What is your preferred method of contact?

What is your phone number?

Additional questions or comments

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Legacy Rest Funeral Home