Order form

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Deceased person
Deceased person *	Fill in name, first name and civil status of the deceased
Date of birth *	Select the date of birth of the deceased	Place of birth *	Complete the city of birth of the deceased
Death date *	Select the date of death
Place of death *	Fill in place of death as well as the zip code and the city
Domiciled in *	Complete the official address of the deceased
National number
Civil status *
of *	Fill in name, first name and civil status of the partner of the deceased
Details about the funeral and ceremony
Type of funeral		Coffin type *	Select the type of the desired coffin
Cemetery *	Complete the municipality where the funeral will take place
Scattering *
Ceremony required
Religion
Church *	Complete the municipality where the ceremony will take place
Pallbearers
Certificates
Price of funeral (excluding municipal taxes) : We undertake to pay on your behalf any taxes arising from the municipalities and/or crematorium.			2500.00 €
Contact person
Relationship *	Complete your family relation with the deceased
Contact person *	Complete your name, first name and civil status
Address *	Complete the address to which we shall send the invoice
E-mail address *	Complétez l'adresse e-mail où nous pouvons vous contacter	Telephone *	Complete your telephonenumber or mobile
Check this box to confirm your order I certify that the data in this form is true and I commissioned B-Funerals company for the Organization of the funeral.
In the event of natural death, we will undertake to proceed with the funeral as soon as possible.

After sending your order, a confirmation e-mail will be sent to you.
We will contact you by phone as soon as possible to confirm the date and time of the funeral.