Online Funeral Pre-Arrangement Form

BIOGRAPHICAL INFORMATION:
Name: Age:
Address: Phone:
City: State/Province: Zip:
Occupation:
Place of Birth: Date of Birth:

Veteran?
Yes No War

Marital Status:
Single Married Widowed Divorced

Church Affiliation:

Clubs/Unions/Civic Organizations:


Father: Living? Yes No
Name: First MI Last

Mother: Living? Yes No
First MI Maiden Married

Spouse: Living? Yes No
First MI Maiden Married

Highest Level of Education Attained:

FAMILY MEMBERS ( LIVING ):
Daughters ( Include City & State of Residence & Phone # )


Sons ( Include City & State of Residence & Phone # )


Sisters ( Include City & State of Residence & Phone # )


Brothers ( Include City & State of Residence & Phone # )


Grandchildren: # Great G.C. Great-Great

Preceded in Death By:
Brothers:

Sisters:

Children:


SERVICE INFORMATION:
Type of Service:
Traditional Cremation

Place of Visitation:
Funeral Home Church Other

Place of Funeral:
Funeral Home Church (Name of Church)

Do you prefer special rites:
Military Masonic Knights of Columbus Other

Attending Clergy:
,

Name of Cemetery
City State/Province

Type of Music:
Piano Organ CD Vocalist Instrumental Only

Song Selections:
, ,

Pallbearers ( Minimum of 6, Maximum of 12 ):
, ,
, ,
, ,
, ,

Type of Flowers:

Memorial Photos Displayed? Yes No

Other Personal Requests:


I would like to meet with a counselor to select services, casket and vault.