For Those Who Would Like To Purchase A Trappist Casket Prior To Need

Purchaser Information

Name of Purchaser:^*
Address:^*
City/State/Zip:^*
Phone:^*
E-Mail:

Casket Beneficiary Information (person's name who will use the casket)

Name of Casket Beneficiary:^*
Address:^*
City/State/Zip:^*
Beneficiary Date of Birth:^*
Age:^*
Social Security # of Beneficiary:(last 4 digits only)^*

NOTE: Purchaser and Beneficiary may or may not be the same person. If you are purchasing the casket for yourself, you are both the Purchaser and Beneficiary. If you are purchasing a casket for someone else (spouse, parent, etc.), the Purchaser and Beneficiary are two different people. The Beneficiary is the person who will use the casket.

Funeral Home Information

Name of Funeral Provider:
Address:
City/State/Zip:
Telephone:
If the funeral provider is unknown, please indicate the likely shipping destination (City & State) of the casket:

Casket Model

Please indicate casket desired:

Premium Rectangular
Premium Shape
Simple Rectangular
Simple Shape

Wood Selection

Please indicate wood species:

Walnut (Available only in Premium Caskets)
Oak (Available in Premium & Simple Caskets)
Pine (Available only in Simple Caskets)

Cross Preference

Please indicate cross preference:

Select With Cross on Lid
Select Without Cross on Lid

How did you first learn about us?

Please tell us how you first learned about Trappist Caskets:

Privacy Guarantee

All personal information provided to Trappist Caskets will be securely protected and will be used exclusively for the above stated purposes. As cloistered monks, we are well practiced in the art of privacy.