Vitals - Pre-Need

  • Information

PLEASE NOTE

All information on this form is required to complete state and federal documents. In order for Direct Cremation Services of Virginia to better serve you, we ask that you please submit all infromation that is asked for.

The information in this step is about the insured and is required to populate state and federal documents.

Vital Information

Address

Is/Was Insured Ever In US Armed Forces?

INSTRUCTIONS FOR ENTERING A DATE
Step 1: CLICK ON CALENDAR IMAGE THEN MONTH & YEAR
Step 2: SELECT MONTH, TYPE YEAR THEN CLICK OK
Step 3: SELECT DESIRED DATE

Is/Was Insured Ever Married, Separated, Divorced or Widowed?

Is Insured Currently In Hospice?

We cannot hold preneed funds longer than 30 days. If the passing of your loved one does not occur within 2 weeks all preneed payments must be placed in a bank trust. Bank trusts will require additional paperwork and a director will be in touch.  

This step asks for the insured's birth information and is required to populate state and federal documents.

Birth Information

INSTRUCTIONS FOR ENTERING A DATE
Step 1: CLICK ON CALENDAR IMAGE THEN MONTH & YEAR
Step 2: SELECT MONTH, TYPE YEAR THEN CLICK OK
Step 3: SELECT DESIRED DATE

In this step, please enter information for the insured's parents. It is required to populate state and federal documents.

Parent Information

This step asks for your contact's information. We require this to populate state and federal forms as well as for communication purposes.

Contact Information

Will They Be Picking Up Remains?

Additional Authorized Individuals?

Purchaser Information
Other Information

Would you like your information presented in an interactive obituary page on our website at your time of passing?

If yes, you can upload a photo and obituary to add to the online listing. (Acceptable file formats: jpg, jpeg, png, doc, docx, rtf, txt)

Please wait