Funeral Planning Survey
Full Name
*
Email
*
Phone (Mobile Number)
Address
*
City
*
State
*
Postal code
*
How old are you?
*
Under 25
24-40
41-65
66 or older
Are you currently:
*
Employed
Retired
Have you ever been responsible for making funeral arrangements?
*
Yes
No
Which of the following would you choose for yourself?
*
Burial
Cremation
How much might you expect to pay for a funeral?
*
Under $5,000
$5,000 - $6,000
$7,000 - $8,000
Over $8,000
Do you own cemetery property?
*
Yes
No
When your death occurs, who would be responsible for making arrangements?
*
Spouse
Children
Family Member
Other
Do your loved ones know what you would want them to choose?
*
Yes
No
Are you aware that pre-paid funeral plans exist?
*
Yes
No
Would you like information or a free consultation about funeral planning, the types of services available, and how you can save money by planning ahead?
*
Yes - by phone
Yes - in person
Yes - by Zoom
I consent to receive text messages and phone calls, including automated, pre-recorded, or AI voice calls, for marketing purposes at the number provided. I understand I can opt out at any time by replying STOP.
By checking this box I agree to receive occasional marketing messages from Harris Funeral Home.
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