Plan Your Funeral

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.

PLAN YOUR OWN FUNERAL

BIOGRAPHICAL INFORMATION

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

Date

City of Birth

State of Birth

Highest Education Level

Please select Grade/Years of Education completed

Residence History

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

Relatives Who Have Preceded In Death

Occupation

Business Type

Company Name

Church Membership

Lodge or Union Name

FOR SECURITY REASONS, WE WILL CONTACT YOU TO COMPLETE THE PREARRANGEMENT.

MILITARY RECORD

Veteran Branch of Service

Date Enlisted

Date of Discharge

Rank at Discharge

Location of a Copy of Discharge (DD214)

Time of Military Service

Military Honors at Graveside

Flag Preference for Service

SERVICE PREFERENCES

Type of Service

Visitation Hours

Casket

Person in Charge of Arrangements

Officiating Clergy: List Clergy Here

Pallbearers: List up to eight pallbearers

Flower Preference

Music Selection

Jewelry

Glasses

Yes

No

Casket Preference

Disposition

Outer Container Preference: (for ground burial)

Cemetery Name

Cemetery Location

Street Address Address Line 2 City State ZIP Code

The cemetery property is in the name of

Miscellaneous Notes and Instructions

Please contact me to schedule an appointment

Yes

No

Please place my information on file

Yes

No

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Comments

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Plan Your Funeral

PLAN YOUR OWN FUNERAL

BIOGRAPHICAL INFORMATION

FOR SECURITY REASONS, WE WILL CONTACT YOU TO COMPLETE THE PREARRANGEMENT.

MILITARY RECORD

SERVICE PREFERENCES

Quick links

Others

Serving Families for over 130 Years!

Plan Your Funeral

PLAN YOUR OWN FUNERAL

BIOGRAPHICAL INFORMATION

FOR SECURITY REASONS, WE WILL CONTACT YOU TO COMPLETE THE PRE­ARRANGEMENT.

MILITARY RECORD

SERVICE PREFERENCES

FOR SECURITY REASONS, WE WILL CONTACT YOU TO COMPLETE THE PREARRANGEMENT.