PRE-ARRANGEMENT FORM

•  Pre-Arrangement Form

All information is kept private and confidential. Information will not be given, transferred or sold to third parties. Bardal Funeral Home respects your right to privacy and operates under a strict privacy policy. If you would prefer, you can give us this information by phone or in person (please call (204) 774-7474).

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Funeral Preferences

Service Type	Undecided Direct Cremation Memorial Service Traditional Earth Burial
Location of Funeral or Memorial Service
Religious Affiliation
Prayers of Visitation	Undecided Prayers Memorial Service

Vital Statistics

Name	*
Address Line 1	*
Address Line 2
City
Province
Postal Code
Telephone
E-mail Address
Place of Birth
Date of Birth
Occupation
Husband/Wife's Maiden Name
Marital Status
Father's Name
Father's Birthplace
Mother's Maiden Name
Mother's Birthplace
Cemetery
Special Instructions