Death Certificate
This information will be transcribed
onto a death certificate.
What is the CID (card identification) number?

The CID (card identification) number is a 3- or 4-digit
code found on your credit card. We are requesting it as
an added security precaution. It's another measure we
take to ensure that your credit card is present when you
place your order.
If your CID number is illegible, call your credit card

Visa, MasterCard and Discover Cards:
The CID (card identification) number is the 3-digit
value printed on the signature panel on the back of
Visa, MasterCard and Discover Cards immediately
following the credit card account number.

Last 3 digits on back of card.

American Express Cards:
The CID (card identification) number is the 4-digit,
non-embossed number printed above your account
number on the face of your card.

Extra 4 digits on front of card.
Name of Deceased
Date of Death
Place of Death
City & State of Death
County of Death
Decedent's Address
Residence City
Residence State & Zip
Date of Birth
Social Security Number
Usual Occupation
Kind of Business
Birth Place
Hispanic Origin ?
Education Level ?
Veteran ?
Veteran Years
Marital Status
Spouse name / incl
Maiden Name
Deceased Father's Name
Deceased Mothers Name
Incl. Maiden
Deceased Race
Next of Kin Name
City, State & Zip
Phone Number
Cell Phone Number
E-mail address
Urn Selection
Additional information
you would like to
Name of Card Holder
Highlight card type
Account Number
Expiration Date
Security code on card
Billing  zip code of
credit card