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Malden - (781) 322-0909 | Mansfield - (508) 339-7595 | Quincy - (617) 472-5319
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Home
Services
Obituaries
Testimonials
About
Locations
Contact

Malden - (781) 322-0909 | Mansfield - (508) 339-7595
Quincy - (617) 472-5319

Call Now - Available 24/7

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Obituaries
About
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Locations
Contact

info@bostoncremation.org

Package Price

When will you require service?(Required)

Immediately- My loved one has passed

My loved one is expected to pass in the next 30 days

I am pre-planning for the future

Details of Individual Completing This Form

Your First Name(Required)

Your Last Name(Required)

Relationship to the deceased(Required)

Your Phone Number(Required)

Your Email(Required)

Name of Deceased(Required)

Deceased First Name Deceased Middle Name Deceased Last Name

Name for Preplan(Required)

Preplan First Name Preplan Middle Name Preplan Last Name

Address

Street Address City State ZIP Code

Sex

Male

Female

Race

Of Hispanic Origin

Yes

No

Please specify:

Date of Birth

Birthplace (City and State)

Social Security Number

Marital Status

Never Married

Married

Divorced

Widowed

Spouse's / Ex-Spouse Name

First Last

Maiden Name

Employment Information

Usual Occupation

(Prior to Retirement)

Kind of Industry

Father's Information

Name

First Last

State of Birth

(country if not USA)

Mother's Information

Name

First Last

Maiden Name

State of Birth

(country if not USA)

Education

Highest Level

Grade 1-8

Grade 9-12 No Diploma

High School Graduate / GED

Trade School / Certificate

Some College, no degree

Associates Degree

Bachelors Degree

Masters Degree

Doctoral/Professional Degree

Unknown

Military Service

Veteran

Yes

No

Branch of Service

Next of Kin Information

Name of Next of Kin(Required)

First Last

Address of Next of Kin(Required)

Street Address Address Line 2 City State ZIP Code

Phone of Next of Kin(Required)

Email of Next of Kin(Required)

Relationship to deceased

Next of Kin/Authorizing Agent:(Required)

I certify and represent that I have the right to make such authorization and am not aware of any living person who has a superior right or any next-of-kin or legal authority that have an objection to this cremation.

Next of Kin / Authorizing Agent(Required)

I agree to hold the cemetery harmless from any liability on account of said cremation. I understand that valuable material including jewelry and dental gold will likely be destroyed and/or not recoverable as a result of the cremation process.

I give Boston Cremation authorization to capture a fingerprint and upload to Legacy Touch in the event I wish to purchase memorial keepsakes now or in the future.(Required)

Yes

No

Deliver the cremated remains via insured, return receipt, first class mail to ($75.00 minimum fee applies).

Yes Deliver Remains

No I Will Pickup at Malden Care Center 287 Main St. Malden, MA 02148

No I will Pickup at Mansfield Location 115 North Main St. Mansfield, MA 02048

No I will Pickup at Quincy Location 116 Franklin St. Quincy, MA 02169

Ship To (Name)(Required)

First Last

Ship To (Address)(Required)

Street Address Address Line 2 City State ZIP Code

Release the cremated remains to the custody of

Authorization

Yes - I give Boston Cremation authorization for cremation and I understand that this is my digital signature

Authorization Name(Required)

First Last

Payment Type(Required)

Credit Card

Pay Offline

Package Total

Payment Information

Name As It Appears On Credit Card

First Last

Billing Address

Street Address Address Line 2 City State ZIP Code

Credit Card Information

Please check if you have activated a Stripe feed for your form.

Name

This field is for validation purposes and should be left unchanged.

Δ

Boston Cremation

Malden

287 Main St Malden, MA 02148
(781) 322-0909

Mansfield

115 N Main St Mansfield, MA 02048
(508) 339-7595

Quincy

116 Franklin St Quincy, MA 02169
(617) 472-5319

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