<%@language="vbscript"%> <% if (cstr(request("Submit")) <> "") then dim cdomail dim mybody dim fromaddr set fromaddr = request.form("contactemail") set cdomail = server.createobject("CDONTS.Newmail") if (fromaddr = "") then cdomail.from = "webmaster@aspenmortuaries.com" else cdomail.from = fromaddr end if cdomail.to = "halkovash@aspenmortuaries.com" cdomail.subject = "Pre-Planning worksheet for " & request.form("firstname") & (" ") & request.form("middlename") & (" ") & request.form("lastname") CDOMail.BodyFormat = 0 CDOMail.MailFormat = 0 mybody = "

This is a pre-planning worksheet generated from your website

" mybody = mybody & "

**** Vital Statistics ****

Name: " & request.form("firstname") & (" ") & request.form("middlename") & (" ") & request.form("lastname") mybody = mybody & "
Social Security Number: " & request.form("ssn") & "
" & "Sex: " & request.form ("sex") & "
" & "Hispanic Origin: " & request.form ("hispanic") & "
" & "Marital Status: " & request.form("marriage") mybody = mybody & "
Education Years Completed: " & request.form("education") & "
" & "Place of Birth: " & request.form ("placeofbirth") mybody = mybody & "
Address: " & request.form("address") & ", " & request.form("address2") & "
City, State, Zip: " & request.form("city") & ", " & request.form("state") & (" ") & request.form("zip") & "
" & "County: " & request.form ("county") & "
" & "Address in City limits: " & request.form ("citylimits") mybody = mybody & "
Occupation: " & request.form("occupation") & "
" & "Industry: " & request.form ("industry") & "
" & "Spouses name: " & request.form ("spousename") & "
" & "Spouses Maiden Name: " & request.form("spousemaidenname") mybody = mybody & "
Mothers Name: " & request.form("mothersname") & "
" & "Mothers Maiden Name: " & request.form ("mothersmaidenname") & "
" & "Fathers name: " & request.form ("fathersname") & "
" mybody = mybody & "

**** Military Service ****
" mybody = mybody & "Service Branch: " & request.form("servicebranch") mybody = mybody & "
Serial Number: " & request.form("serialnumber") mybody = mybody & "
Place Enlisted: " & request.form("placeenlisted") mybody = mybody & "
Date Enlisted: " & request.form("dateenlisted") mybody = mybody & "
Place Discharged: " & request.form("placedischarged") mybody = mybody & "
Date Discharged: " & request.form("datedischarged") mybody = mybody & "
Copy of Enlistment Papers: " & request.form("copyofpapers") mybody = mybody & "

**** Funeral Details ****" mybody = mybody & "
Service Option: " & request.form("serviceoptions") mybody = mybody & "
Place of Service: " & request.form("placeofservice") mybody = mybody & "
Church: " & request.form("church") mybody = mybody & "
Denomination: " & request.form("denomination") mybody = mybody & "
Viewing for Family: " & request.form("viewingforfamily") mybody = mybody & "
Viewing for Friends: " & request.form("viewingforfriends") mybody = mybody & "
Prefered: " & request.form("prefer") mybody = mybody & "
Name of Cemetery: " & request.form("nameofcemetery") mybody = mybody & "
Cemetery City: " & request.form("cemeterycity") mybody = mybody & "
Cemetery State: " & request.form("cemeterystate") mybody = mybody & "
Grave or Niche Location: " & request.form("gravelocation") mybody = mybody & "
Favorite Musical Selection 1: " & request.form("music1") mybody = mybody & "
Favorite Musical Selection 2: " & request.form("music2") mybody = mybody & "
Favorite Musical Selection 3: " & request.form("music3") mybody = mybody & "
Favorite Musical Selection 4: " & request.form("music4") mybody = mybody & "
Favorite Bible Passage, Literature, or Poem 1: " & request.form("passage1") mybody = mybody & "
Favorite Bible Passage, Literature, or Poem 2: " & request.form("passage2") mybody = mybody & "
Favorite Bible Passage, Literature, or Poem 3: " & request.form("passage3") mybody = mybody & "
Favorite Bible Passage, Literature, or Poem 4: " & request.form("passage4") mybody = mybody & "
Special Requests: " & request.form("specialrequests") mybody = mybody & "

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Contact Day Phone: " & request.form("contactdayphone") mybody = mybody & "
Contact Evening Phone: " & request.form("contacteveningphone") mybody = mybody & "

" & request.form("contact") mybody = mybody & "

**** End Of File ****" cdomail.body = mybody cdomail.Send set cdomail = Nothing response.redirect("index.htm") end if %> Aspen Mortuaries and Funeral Homes - Funeral and Crematory Services in Denver, Colorado. Offices also in Lakewood - Golden - Arvada and Commerce City.


1350 Simms Street
Lakewood, CO 80401
303-232-0985


6370 Union St.
Arvada, CO 80004
303-422-8882


6580 E. 73rd Ave.
Commerce City, CO 80022
303-287-0495

The purpose of this form is to provide a written record of your final wishes, so that your family and your Funeral Director will have this information available upon your death. A permanent I.D. card will be issued stating that this information is on file at the Funeral Home, and available for the purpose of arranging your Funeral/Cremation, 24 hours a day, 7 days per week.

Vital Statistics
(All information will be held strictly confidential)
 
First Name:
Sex:
Hispanic Origin:
Middle Name:
Marital Status:
Last Name:
Education:
(years completed)
Date of Birth:
Place Of Birth: (city and state)
Social Security Number:
Street Address:
Address Cont:
City:
County:
State: Zip: Is home address inside city limits?
Occupation:
(most of adult life)
Industry:
Spouse's Name:
Spouse's Maiden Name:
Mother's Name:
Mother's Maiden Name:
Father's Name:  

Military Service
 
Service Branch: Serial Number:
Place Enlisted: Date Enlisted:
Place Discharged: Date Discharged:
Do you have a copy of discharge papers?

Funeral Details
 
Service Options:
Place Of Service: 
Church:
Religious Denomination:
Viewing for Family:
Viewing for Friends:
I Prefer
Name of Cemetery:
City: State:
Grave or Niche Location:
Favorite Musical Selections:
Favorite Bible Passages, Literature or Poems:


Special Requests
Name:
Relationship:
Address:
Daytime Phone:    Evening Phone:
Email:
Person To Finalize Arrangements At Time Of Death

Thank You
 
 
Please call to arrange an interview
Keep Information On File