Funeral Date
-
Month
-
Day
Year
Date
Funeral Home
Funeral Home Contact
*
Funeral Home E-mail
Funeral Home Phone
*
-
Area Code
Phone Number
Deceased Full Name
Plan B Package
$300 (Includes equipment delivery and pick up, pending scheduling)
Other
Video Access
Public (Typical)
Password Protected
Desired Password
Video Delivery:
Simulated Live Stream
Send Link When Video Ready
Simulated Stream Date and Time:
Requested camera drop off date & time
Requested camera pickup date & time
Payment Via:
Funeral Home will pay by check.
Other
Would you like a USB flash drive?
Yes, please mail to Funeral Home
No USB needed
Anything else?
Submit
Should be Empty: