Please complete the details below for the person whose burial is being considered. If a burial is required immediately, Please Call 1300 466 860 (24 hours). If you need assistance completing this form, please call us on 1300 466 860. Page 1 of 6 - Full Name of Person whose burial is being considered. Back Next Page 2 of 6 - Address and Contact Details of Person whose burial is being considered. * Back Next Page 3 of 6 - Alternative Contact Person Back Next Page 4 of 6 - A Quick Survey How did you hear about us? Select Radio Newspaper Other Comments 1 What attracts you to the service? Select Simplicity Environmental Economical Other Comments 2 Back Next Page 5 of 6 - Assistance with Payment Would you like assistance in organising a burial pre-payment? yes, please call me no thankyou Back Next Page 6 of 6 - Terms & Conditions. I accept the Terms and Conditions - Click Here to Review.;I accept the Terms and Conditions. Send Form Back Next