CYRUS | Partner Registration

Branch

Name of the Business *

Physical Address 1 *

Physical Address 2 *

Physical Address 3

Postal Code *

Country *

State *

City *

Main Business Telephone *

Business License*

First Name *

Middle Name

Last Name *

Mobile Phone *

Email *

Designation

Is your office located at the business address given on prior screen?

Month/Year established *

Number of Funeral Directors/Embalmers on staff *

Number of casketed funerals annually *

Number of cremations annually *

Annual preneed volume *

$

I hereby authorize Cyrus Life or an Agency appointed by Cyrus Life to verify the submitted records.