Online At-Need Funeral Planning
You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.
I. Biographical Information
Full Name:
Date of Death:
Address1
Address2:
City Name:
State:
Zip Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth:
(month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
- -
Elementary
Secondary
College/University
Please select Grade/Years of Education completed:
--
0
1
2
3
4
5
6
7
8
9
10
11
12
Social Security Number:
For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Enter Text Here...
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Enter Text Here...
Relatives Who Have Preceded In Death
Enter Text Here...
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:
II. Military Record
Veteran:
Yes
No
Branch of Service:
None
Army
Navy
Air Force
Marines
Coast Guard
National Guard
Serial Number:
Date Enlisted:
(month/day/year)
Date of Discharge:
(month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Enter Text Here...
Time of Military Service:
Not a Veteran
Peacetime
World War I
World War II
Korean War
Vietnam War
Persian Gulf War
Military Honors at Graveside:
Not a Veteran
Yes
No
Flag Preference for Service:
None
Drape Casket with Flag
Folded Flag on Casket
III. Service Preferences
Type of Service:
Chapel Service
Church
Graveside
None
Visitation Hours:
Day
Night
None
Casket:
Open for service
Closed for service
No public viewing
Person in Charge of Arrangements:
Officiating Clergy:
List Clergy Here...
Pallbearers:
List up to eight pallbearers
Flower Preference:
Enter Flower Preference...
Music Selection:
Enter Music Selection...
Jewelry:
No jewelry
Give to family
Leave jewelry on
Glasses:
No glasses
Donate to Lions Club
Leave on
Give to family
Casket Preference:
Select a Casket
Bronze
Copper
Stainless Steel
Steel (sealing)
Minimum Metal
Mahogany
Walnut
Cherry
Maple
Poplar
Pine
Fiberboard / Veneer
Disposition:
Select Disposition
Ground burial
Mausoleum
Cremation
Outer Container Preference: (for ground burial)
Select a Burial Container
Bronze Triune
Copper Triune
Cameo Rose
SST Triune
Veteran
Venetian
Continental
Monticello
Minimum Grave Liner
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:
Miscellaneous Notes and Instructions:
Enter Text Here...
Please select one of the options below:
Please send me information
Please contact me to schedule an appointment
Please place my information on file
Admin
|
Privacy Policy
|
Site Map
| Matthews IMS 4.0 | Powered by
FrontRunner
&
TA