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Pre-Arrangement Form
If you would like to pre-arrange cremation services with Clearview, please complete the form below at your convenience. Once received, we’ll prepare your personalized pre-need contract and promptly follow up to collect signatures and arrange for payment. Our goal is to make this process as simple, secure, and stress-free as possible. If you are completing this on behalf of a loved one who is expected to pass soon (for example, someone currently in hospice or in the hospital), please call or text us directly at (855) 704-3344 instead of filling out this form so we can assist you right away and make the process as seamless as possible.
Who is filling out this form?
(Purchaser Information)
Full Legal Name
*
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What is your relationship to the person this prearrangement is for?
*
Self
Husband
Wife
Child
Brother
Sister
Mother
Father
Other
Who is this prearrangement for?
Please provide information about the person whose arrangements are being made.
Full Legal Name
*
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Beneficiary's Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Death Certificates
Each Clearview Cremation package includes one certified death certificate at no additional cost. If you would like additional copies, please enter the number below.
OPTIONAL: Additional Long-Form Death Certificates ($15 each)
These include the cause of death and Social Security number, which are often needed for banks, insurance, pensions, and other official matters.
OPTIONAL: Additional Short-Form Death Certificates ($15 each)
These do not include cause of death or Social Security number and are typically used for personal records or non-financial matters.
Payment Preferences
Duration of Payment
*
Upfront in full
Twelve (12) months
Twenty-four (24) months†
Thirty-six (36) months†
† Longer-duration payment plans may include an extended payment fee.
Desired Method of Payment
*
Bank Account (Routing & Account Number) — Recommended
Credit or Debit Card
Refundability of Prearrangement Funds
*
Refundable — Revocable (Recommended for most people; principal may be refunded if canceled)
Nonrefundable — Irrevocable (Typically used for Medicaid eligibility or spend-down planning; principal cannot be refunded)
Comprehensive Travel Protection
Travel with total peace of mind. By adding Comprehensive Travel Protection, you are covered whenever you are more than 75 miles away from your primary residence. This one-time membership ensures your loved ones will never face unexpected expenses or complicated logistics during a difficult time. Would you like to add Comprehensive Travel Protection to your plan for a single, one-time payment?
*
Yes (+$495)
No
Click Here to Learn More
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Last Four Digits of SSN
*
Submit
Should be Empty: