Direct Mail Survey
Full Name
*
Cell #
*
Home #
Email
*
What language do you prefer
*
English
Spanish
Best Time to call
*
AM
PM
What is your current age?
*
0-49
50-59
60-69
70-79
80-89
90+
Have you ever been responsible for making funeral arrangements?
*
Never
In last 12 months
12-24 months ago
Over 2 years ago
How much might you expect to pay for a funeral?
*
$1,000-$3,000
$3,000-$5,000
$5,000-$7,500
$7,500-$10,000
Over $10,000
Funeral home location
*
Location 1
Location 2
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What type of service do you desire?
*
Burial
Cremation
In the event of your death, who would be responsible for making arrangements?
*
Spouse
Children
Family Member
Other
Are you going to be personally responsible for making funeral arrangements for a loved one or close friend?
*
Yes
No
Have you ever considered a prepaid funeral plan?
*
Yes
No
Would it give you peace of mind to know you could do the planning in advance and that your family would not have to make arrangements?
*
Yes
No
Would you like FREE information about funeral planning and the types of services which are available?
*
Yes
No
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