PLAN YOUR OWN 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.

BIOGRAPHICAL INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Date
MM slash DD slash YYYY
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
MM slash DD slash YYYY
Date of Discharge
MM slash DD slash YYYY
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
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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.