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1-833-UPRMLLC (877-6552)
Home Page
First Call Inquiry
PRIMARY CONTACT INFORMATION
First Name*
Email
Funeral Home/Facility Name*
Last Name*
Phone*
Primary Address*
PATIENT DETAILS
Service Type
How many stairs
Hospital Room #, and Floor #
Nursing Home Room #
First Name
Last Name
Weight (+$75 over 225lbs)
Gender
Race
Cause of Death
TRANSPORT INFORMATION
Primary Contact (Pick-up location)
First Name*
Phone Number*
Pick-up Date
Drop Off Address*
Last Name*
Pick-up Address*
Pick-up Time
Deceased Needed by what time?
Any additional information
Submit
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