MOORE-OVERLEASE FUNERAL HOMES

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 Code:

Phone Number: - -

E-Mail Address (Required)

BIOGRAPHICAL INFORMATION

Date of Birth:

Place of Birth:

Father's Name:

Mother's Name:
Mother's Maiden Name:

Social Security Number: - -

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 burial container 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