Pre-Arrange Online

Preplanning your own, or a loved one's, funeral prior to death allows you to express your own wishes. Preplanning relieves your family of making stressful decisions at a difficult time. Preplanning does not require prepayment, however, a prepayment option is available.

The Burns Funeral Home is here to assist you with your funeral preplanning. You can contact us to arrange a time to meet, or you can start the process by completing and submitting this form. If you wish for the Burns Funeral Home to contact you to arrange a meeting to discuss all of your options, please choose the appropriate option at the bottom of the form. If you wish, we can also file the information until you are ready to meet in person.

Please Note: This form should not be used to report a death of a loved one. In those cases, please immediately call the funeral home to make the proper arrangements at 978-663-3968 (Billerica) or 617-876-8336 (Cambridge).

Your Information

Full Name*:

Mailing Information

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Social Security Number:

Email Address*:

Phone Number:

Date of Birth:

City of Birth:

Please enter the your race as it will be listed on the death certificate

Race:

Sex*:

Male

Female

Marital Status:

Father & Mother Information

Father's Name:

Father's State of Birth :

Please enter your father's state of birth if he was born in the U.S.A. If not, please enter country of birth

Mother's Name:

Mother's Maiden Name:

Mother's State of Birth:

Please enter your mother's state of birth if she was born in the U.S. If not, please enter the country

Spouse's Information

Spouse's Name:

Spouse's Maiden Name:

Spouse's Address

Address:

City:

Country:

State/Province:

Zip/Postal code:

Work & Education

Education:

Your Occupation (Prior to Retirement):

Kind of Business:

Company Name:

Military Information

Branch Service:

Serial Number:

Date Enlisted:

Rank at Discharge:

Date Discharged:

Discharge on File at:

Copy of Discharge Papers:

Yes

Funeral Service Information

Place of Service:

Would you like to have a viewing?*:

Yes

I Prefer the Funeral Service To Be:

Religious Denomination:

Place or Worship:

Next of Kin Information

Full Name:

Address

Address:

City:

Country:

State/Province:

Zip/Postal code:

Telephone Number:

E-Mail Address:

Disposition Information

I Prefer:

Cemetery:

Address:

Phone:

Additional Information

Please include anything about yourself that you may want included in your obituary

Obituary Information:

Music Selections:

Casket Pallbearers:

Special Instructions

Memorials & Charities:

Other Information:

Send Information

Please select one of the options below:

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