Haine Funeral Home & Chapel
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      Online Prearrangement

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      Prearrangement Information


      Title
       

      Surname

      Given Names
       
      Maiden Name
       

      Sex
      Male   Female

      Date of Birth
       
      Place of Birth
       

      Address
       
      City
       
      Province
       
      Postal Code

      Phone
       
      Email
       

      Marital Status


      Fathers Name

      Birthplace 

      Mothers Name (Maiden)
      Birthplace


      Kind of Business
       
      Type of Work
       


      Spouse


      Title
       
      Surname
       
      Given Names
       
      Maiden Name
       


      Executor


      Title

      Surname
       
      Given Names
       
      Address
       
      City
       
      Province
       
      Postal Code
       
      Phone Number
       
      Email
       


      Church Affiliation
       


      Cremation     Burial     Entombment


      Is Cemetery Prearranged ?
      Yes     No    Not Applicable
      Cemetery Name ?
       


      Information for Obituary



      Additional Comments




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      Contact Us


      905-227-1732

      info@hainefuneralhome.com

      26 Ormond Street South

      Thorold, ON L2V1Y4

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      Funeral Director

      on call 24 hours

       

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        License 527-Funeral Establishment Class-1

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