Offer request
Contact details :
Surname :
First Name :
Address :
NIP/City :
Country :
Telephone :
Mobile :
Fax :
E-mail :
Is this request on behalf of a deceased
person ? :
yes
No
If so : details of the deceased :
Surname :
First Name :
Sex :
Date of Birth :
Date of death :
If not : details of the future benefactor:
Surname :
First Name :
Adress :
NIP/City :
Country :
Telephone :
Mobile :
Fax :
E-mail :
Type of service required :
Choice of site:
Eternal snow
Flowering meadows
Lakes
Rivers
Forests
Mountains
Mourners:
Yes
Total number :
No
Available dates of the mourners:
Additional services required
Farewell drink
Meal
Airport transfer - Meeting point
Translator
Video film of the ceremony
Commemorative tree
Exceptional services required :
Religious ceremony
Religion :
Special transport : (plain, hot-air balloon, helicopter)
Transport :
Military honours
Special requests : (please indicate)
General comments :