LifeMemoriam

Partner Application

Offer permanent digital memorials as part of your services. Complete the application below and our team will review it within 2–3 business days.

Organization Information

Legal Business Name *

DBA Name (if different)

Organization Type *

EIN / Tax ID

Street Address *

City *

State *

ZIP *

Business Phone *

Website

License Number

State funeral/professional license

Years in Operation

Estimated Annual Services

Primary Contact

First Name *

Middle Name

Last Name *

Title / Position *

Direct Phone *

Email Address *

Confirm Email Address *

⚠ Please double-check your email. If approved, your login credentials will be sent to this address.

Government ID Type

ID Number

Encrypted and stored securely

How did you hear about LifeMemoriam?

I confirm that I am authorized to represent the organization listed above and I agree to the LifeMemoriam Partner Agreement. I understand that this application is subject to verification and approval by LifeMemoriam.