Mosaic Funeral, Cremation & Cemetery Services

1839 Inkster Boulevard

Winnipeg, MB R2X 1R3

Phone: (204) 275-5555

Fax: (204) 632-9149

Email: info@mosaicfunerals.ca

Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Obituaries & Tributes

It is not always possible to pay respects in person, so we hope that this small token will help.

Order Flowers

Offer a gift of comfort and beauty to a family suffering from loss.

Pre-Arrangement

A gift to your family, sparing them hard decisions at an emotional time.

Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

I. Biographical Information
Full Name:
Date of Death:
Address1:
Address2:
City Name:
Province:
Postal Code:
Telephone Number:	(xxx-xxx-xxxx)
Email Address:
Date of Birth:	(month/day/year)
City of Birth:
Province of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:

Social Security Number:	For security reasons, we will contact you to complete the pre-arrangement.
Residence History:	Enter Text Here...
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence	Enter Text Here...
Relatives Who Have Preceded In Death	Enter Text Here...
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:
II. Military Record
Veteran:
Branch of Service:
Serial Number:
Date Enlisted:	(month/day/year)
Date of Discharge:	(month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):	Enter Text Here...
Time of Military Service:
Military Honours at Graveside:
Flag Preference for Service:
III. Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:	List Clergy Here...
Pallbearers:	List up to eight pallbearers
Flower Preference:	Enter Flower Preference...
Music Selection:	Enter Music Selection...
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:
Miscellaneous Notes and Instructions: Enter Text Here...
Please select one of the options below: Please send me information Please contact me to schedule an appointment Please place my information on file

365 Days of Healing

Grieving doesn't always end with the funeral: subscribe to our free daily grief support email program, designed to help you a little bit every day, by filling out the form below.

52 Weeks of Support

It's hard to know what to say when someone experiences loss. Our free weekly newsletter provides insights, quotes and messages on how to help during the first year.

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Mosaic Funeral, Cremation & Cemetery Services

Order Flowers

Immediate Need

Obituaries & Tributes

Order Flowers

Pre-Arrangement

Online At-Need Funeral Planning

365 Days of Healing

52 Weeks of Support