Sender .       (* required fields)

E-mail sender*

Mr / Mrs *
please choose Mr. Mrs. Company

Name *

First name *

Company name

City - location - postal code *

Country *

Address - street - no.

Date of birth

Phone - Fax

Your relation to deceased

Place of death.

Name hospital etc. *

City - location - postal code *

Address - street - no.

Other place of death
at which location is the deceased now?

Name - location - etc. *

City - location - postal code *

Address - street - no.

Cause of death *
please choose natural death accident unknown

If it was not a natural death
reponsible police department.

Name - location - etc

City - location - postal code

Address - street - no.

Phone

Reference Number

Transfer to?

Country *

City - location *

transfer with airplane - destination aiport *

Name and address of the cemetery or
name and address place of delivery e.g. funeral home or
name and address of the funeral director who will collect the coffin from the airport.

Cemetery - place to deliver - funeral director *

City - location - postal code *

Address - street - no.

Phone

Fax

E-mail

Contact person

Information of the deceased.

Mr.  / Mrs. *
please choose Mr. Mrs.

Name *

First name *

Birth name *

Date of birth *

Place of birth *

Family status *
please choose family status single married widowed divorced

City - location - postal code *

Address - street - no. *

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We will contact you with a preliminary cost estimate. Should you decide not to place an order with us all the information you entered above will be deleted. .