Endswell Funeral Home | Make Modern Funeral Arrangements

Planning

Who are these arrangements for?

For Myself
For Someone Else

When are these arrangements for?

Pre-Arrangement for Future
I Need Services Now

Would you like to provide your basic contact information or complete our full Intake Form?

Basic Contact Information
Full Intake Form

Future Planning for Yourself

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Information for Your Loved One

Name

First

Last

Primary Contact For Follow Up

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Message

Please specify if you are interested in Aquamation, Cremation, or Green Burial and provide any relevant Notes / Requests / Questions

Contact Details

Email of Individual Completing Form

If you are filling out this form for someone else, please provide your name, email, phone number, and address, as well as your relationship to the individual for whom these arrangements are being made.

First

Last

Phone Number of Individual Completing Form

Address of Individual Completing Form

Address Line 1

Address Line 2

City

State

Zip Code

Relationship to the individual for whom the funeral service is being arranged.

Full Legal Name - This is the full legal name of the individual for whom the funeral service is being arranged.

First

Middle

Last

Are there any aliases?

Please provide the legal residence.

Address Line 1

City

State

Zip Code

In what County is the legal residence located?

Is the legal residence inside the city limits?

Yes
No

Please Enter Date of Birth

Personal Details

Current Marital Status

Please provide spouse's full legal name.

First

Middle

Last

Please provide spouse's full name prior to first marriage.

First

Middle

Last

Last name prior to first marriage

Father's full name prior to first marriage

First

Middle

Last

Mother's full name prior to first marriage.

First

Middle

Last

Other Information

Next of kin (N.O.K.) name, relationship, phone number, and email address

The next of kin will authorize Endswell to proceed with the aquamation, cremation, or green burial service. If married, please provide contact information for spouse. If divorced, separated, or never married, please provide contact information for children, if any. If there are multiple children, please provide their names and contact information. If there are no children, please provide information for siblings or parents.

If there are any special spiritual or religious requests or if you or the family would like to arrange a viewing (visitation) of the body, please note them here.

Other Details

How many death certificates would you like us to order?

Do you want to pickup the urn at Endswell or have the urn delivered?

Pickup at Endswell
Have the urn delivered

For aquamation and cremation services, to whom should we deliver the urn?

First

Last

To where should we deliver the urn?

Address Line 1

Address Line 2

City

State

Zip Code

If you have a cemetery plot, what is the name of the cemetery?

Immediate Need

The following questions are necessary when there is a need for services in the immediate future.

Is there an immediate need for services from Endswell?

Yes
No

If you anticipate the need for our services in the coming days or weeks, please select YES.

If you are working with hospice, please enter their name and contact number.

Name of hospice contact

First

Last

If death has occurred, what is the address at that location?

Address Line 1

Address Line 2

City

State

Zip Code

If death has occurred, what County did it occur in?

If there is a doctor or nurse practitioner you are working with, please provide their name and contact number.

Name of doctor or nurse practitioner

First

Last

Endswell

Our Team

Testimonials

News and Events

Service Areas

Chapel Hill North Carolina

Raleigh North Carolina

Cary North Carolina

Durham North Carolina

Greensboro North Carolina

Hillsborough North Carolina

What is Aquamation

Aquamation Cost

Arrange Aquamation Service

What is Cremation

Cremation Cost

Arrange Cremation Service

What is Green Burial

Green Burial Cost

Green Burial Grounds

Arrange Green Burial Service

Planning Resources

Make Arrangements

Bluestem Conservation Cemetery

Make Arrangements

REQUEST FOR ENDSWELL’S SERVICES

Planning

Future Planning for Yourself

Information for Your Loved One

Primary Contact For Follow Up

Message

Contact Details

Personal Details

Other Information

Next of kin (N.O.K.) name, relationship, phone number, and email address

Other Details

Immediate Need

If you are working with hospice, please enter their name and contact number.

If there is a doctor or nurse practitioner you are working with, please provide their name and contact number.

Ready to get started or want to learn more?