Signed in as:
filler@godaddy.com
Signed in as:
filler@godaddy.com
This form is required by the service provider. It contains all the vital information needed to process your arrangements, to secure regulation permit, death certificates, identify your legal next of kin and emergency contact information.
The Decedent's info section is the person who is preplanning. The Informant section is for the legal next of kin.
For your convenience, we recommend to use a desktop computer to download the form and complete it in preparation for your enrollment.
Being that your funeral plan is funded through a funeral life policy, personal identification information will be required, such as ID verification for name, address, date of birth, and social security number.
You can also think of at least two people you would like to assign as contacts. Typically they would be the ones meeting with the funeral home for your final arrangements. Therefore please have their names, addresses, emails, and phone numbers ready for sharing.
Acceptable forms of payment can be either credit cards or EFT (Electronic Transfer Fund). You have the choice to pay in full or enroll in a payment plan. We do not accept cash payments.
Your enrollment application is confirmed within a few hours and could take about 3 weeks for mailing.
When planning for cremation, our service provider requires the signature of witnesses for this irreversible process. Your preplanning specialist will be the first one and you need to find a second witness ready to sign electronically via DocuSign if you're planning for cremation. This is not required for traditional burial.
The funeral home will keep this completed form to process your permit and death certificate at the time of need. If possible, please complete contact information of at least three (3) people for us to reach out as necessary.
Protect My Heritage
2810 W. Charleston Blvd., #72, Las Vegas, NV 89102
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