Death Application Form

Applications must be placed at least 2 months before death. Every application can be voided if stated so within 7 weeks of placing application. After this there is nothing we can do to prevent your death. Please put a tick next to you chosen option. More than one option can be chosen from each category.

Remember this applcation can be for you or a friend.

Name of Victim:
Date of Death:
Time death will begin:
Place of Death:
	Home	School / College
	Work	While having sex
	Public Toilet	Shop
	Air Ballon	Suprise Me!

Type of death:	Illness		Accidental
	Mysterious		Alcohol poisioning
	Killed		Suicide / self inflicted
	Killed (execution style)		Suprise Me!

The death will be:	Quick	Embarassing
	Slow	Brutal
	Painful	Tragic

Extras:	Previous mental breakdown	Buried while still alive
	Whiped by 70yr old french hoe	Stoned by angry mob
	Coke	Burned at midnight
	Garlic Bread	Stake through heart

After Death:	Raped by hairy trucker	Eaten by cannibals that live in the sewers
	Used in satanic ritual	Stuffed and given to family
	Studied by science people	Stored in Sainsbury's freezer department
	Torn apart by wild dogs	Body appears in X-files episode
	Eaten by pidgeons	Rise as the new jesus

If buried What do you want put on your tombstone

If your/there not going to be buried but are feeling some how cheated by not having a tomb stone then please state what you want us to graphiti on somebody else’s tombstone:

What Song(s) do you want played at your funeral / wake:

What Do you want to be remembered by:

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