Pre-Arrangements

We Welcome Pre-Arrangement Transfers, call us to answer any questions you might have.

It is a privledge to serve you and your family.


There are many important reasons for prearranging a funeral. Not only does pre-planning ensure all your special preferences are met, but it helps make the funeral process run more smoothly for your loved ones. You can even make funeral prearrangements with us at no expense, if you want to simply keep your wishes on file. We also offer a variety of affordable cost protection plans for those who want every thing taken care of in advance and our nursing home/Medicaid spend down programs. We have carefully designed a simple step-by-step program that will take you through the prearrangment process.

PERSONAL INFORMATION
Last Name:
First Name:
Middle Name:
E-mail:
Address:
City:
State:
Zip Code:
Phone:

VITAL STATISTICS
Marital Status: Social Security #:
Date of Birth (mm/dd/yy): Place Of Birth:
Spouse's Name: Spouse's Maiden Name:
Place of Marriage: Date of Marriage:
Father's Name: Mother's Name:
Mother's Maiden Name:

WORK/EDUCATION
Education (0-12):
College 1-5+:
Occupation:
Business:
Company:

MILITARY RECORD
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Copy of Discharge Papers:
Name Of Wars:

FUNERAL SERVICE INFORMATION
Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:

SPECIAL INSTRUCTIONS
Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:

DISPOSTION REQUEST
I Prefer:
Cemetery:
Address:
Phone:
Section:
Location:
I have made a last will and testament:    Yes    No


OTHER INSTRUCTIONS
Please list any other instructions you may have: