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Let's Start with Name and Phone # of "Who to Contact to Discuss Prearrangement Details"*

First Name*

Middle Name*

Last Name*

Current Street Address

City/Town

Province

Postal Code

Email*

Phone Number*

Date of Birth

Place of Birth

Social Insurance Number*

Are you receiving CPP/OAS?

Occupation During Working Life and Industry

Marital Status

Name of Spouse (if applicable)

Maiden name of Spouse (if applicable)

Date of Marriage(if applicable)

Fathers Name

Father’s Place of Birth

Mothers Name

Mother’s Place of Birth

Do you have a will?*

Lawyer’s Name and Phone Number

Executor's Name*

Executor's Phone*

Executor's Email

Next of Kin Name

Next of Kin Phone

Next of Kin Email

Next of Kin Name

Next of Kin Phone

Next of Kin Email

First name

Middle Name

Last Name

Current Street Address

City / Town

Province

Postal Code

Phone Number

Date of Birth

Place of Birth

Social Insurance Number

Are you receiving CPP/OAS?

Occupation During Working Life and Industry

Marital Status

Name of Spouse (if applicable)

Maiden name of Spouse (if applicable)

Date of Marriage (if applicable)

Father’s Name

Father’s Place of Birth

Mother’s Name at Birth

Mother’s Place of Birth

Do you have a will?

Lawyer’s Name and Phone Number

Executor’s Name

Executor's Phone

Executor's Email

Next of Kin Name

Next of Kin Phone

Next of Kin Email

Next of Kin Name

Next of Kin Phone

Next of Kin Email

Wall-Custance Funeral Home & Chapel

Wall-Custance Funeral Home & Chapel

Wall-Custance Funeral Home & Chapel

Funeral & Cremation Services

Wall-Custance Funeral Home Ltd.

Memorial Forest Program

Wheelchair Accessible

Contact Info

Services we offer

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