Prearrangement Inquiry

By taking a few moments to complete the form below, we will be able to provide you with the exact information you want. We will respond to your request as soon as possible.

 
CONTACT INFORMATION
First Name:
Middle Initial:
Last Name:
Address:
City:
State: Zip:
Phone Number: --
E-Mail Address (Required):
 
BIOGRAPHICAL INFORMATION
Date of Birth:
Place of Birth:
 
Father's Name:
Mother's Name:
Mother's Maiden Name:
 
Occupation:
Type of Business:
Name of Employer:
Years Employed:
Year Retired:
 
Veteran: Yes No
If yes, which branch?:
Service Number:
Period of Service:
Date of Entry:
Date of Discharge:
 
Are you a member of a church?: Yes No
If you are, what is the name of your church?:
 
Please list any groups, clubs or organizations you are involved in.
 
FAMILY MEMBERS
FIRST AND LAST NAME RELATIONSHIP
 
SERVICE INFORMATION
Do You Prefer:
  Burial Cremation
 
Do You Already Own Cemetery Property?
  Yes No
Name of Cemetery:
 
What Type of Service Do You Want?
 Traditional
 Graveside Service With Visitation
 Graveside Service Without Visitation
 Traditional Service Followed By Cremation
 Cremation With A Memorial Service
 Cremation With No Service
 
Where Would You Prefer To Have Your Service?
 Funeral Home
 Your Church
 Cemetery
 
Would you like to have a limosine to take your family to the place of your service and to the cemetery?
  Yes No
 
Do you have a minister that you would like to have speak at your funeral?
  Yes No
If you do, what is their name?
 
Please list any special music you would like us to play at your service.
 
Do you know who you would want to serve as pallbearers?
  Yes No
If so, you can list their names here.
 
 
 
 
 
 
Would you like to have a limosine to take the pallbearers to the cemetery?
  Yes No
 
CASKETS
Do You Prefer:
  Metal Caskets Wood Caskets
 
OUTER BURIAL CONTAINERS
Do you want an outer bural containter that:
  Is Not Waterproof (Grave Liner) Is Waterproof (Vault)
 
OTHER INFORMATION YOU WOULD LIKE
Please feel free to use the space below to ask any other questions you may have and we will do our best to answer them.
At this time, what would you like us to do with the information you have provided?
  Just keep information on file. Keep information on file and contact me about prepaying.
 
WOULD YOU LIKE US TO ANSWER YOUR REQUEST BY:
 Phone
 E-mail
 Regular Mail
 


You may use the boolean operators 'AND' & 'OR'

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