Client Intake FormInformation used to fulfill ordersPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Email Address *EmailConfirm Email and Full on Your Phone Number *Your Relationship to the Deceased *Your Mailing Address *Deceased Full Name as inscribed on the headstone *First Name, Middle Name or Initials and Last NameDate of Birth and Date of Death *Additional Inscriptions on GravestoneCemetery Name and Full Address *Cemetery Plot Details *Section, Lot, Row, Block, Plot Number, GPS coordinates. Any landmarks or anything to help find the exact location of loved one.Type of Service Ordered *Gravesite Visitations -12 Visits Per Year - Real FlowersGravesite Visitations -12 Visits Per Year - Artificial FlowersGravesite Visitations -12 Per Year - No FlowersGravesite Visitation Subscription 4 Visits Per MonthGravesite Visitation - One TimeGravesite Virtual Visit - One TimeGravesite Flowers - Artificial Flowers Placement - One TimeGravesite Flowers - Fresh Bouquet Placement - One TimeGravesite Cleaning & Maintenance - Extra Large Headstone - One TimeGravesite Cleaning & Maintenance - Large Basic - One TimeGravesite Cleaning & Maintenance Medium Basic - One TimeGravesite Cleaning & Maintenance Small - One TimeSpecial InstructionsItems to leave, flower & color preferences, Message or Prayer to be read aloud.Special Time & Date RequestsVisits, Flower Delivery, Personal Items and Video Calls Time RequestsAccess & Permissions *Does the cemetery require gate passes? Entrance Instructions? On-site contact person or phone number?Preferred Visit Reporting & CommunicationsPhoneEmailClient PortalFacetime - Apple Phones OnlyDo you have photos of gravestone or location? *YesNoMaybeIf you have any photos, please email them to admin@gravesitevisits.net (Place your name and photos attached in the subject line)What do you expect?We want to make you happy, please tell us what you are hoping from us?Submit
