Getting Started

 

I am Planning For My Select One Self Spouse Parent Child Friend Relative Sibling Other

 

Details of the Person for whom you're planning for

 

First Name

 

Middle Name

 

Last Name

 

Your Information

 

First Name

 

Last Name

 

Phone Number

 

E-mail Address

 

Initial Choices

 

Does Your Plan Include Cremation?

Yes
No

 

Viewing/Visitation Options

Viewing or Visitation at the Funeral Home
Viewing or Visitation at a different facility
No Viewing or Visitation

 

Ceremony/Service Options

Funeral Ceremony at the Funeral Home
Funeral Ceremony at Another Facility
Memorial Service at the Funeral Home
Memorial Service at Another Facility
No Funeral Ceremony or Memorial Service

 

Biographical Information

 

Information on Person For Whom Plan if Written

 

Gender

Male
Female

 

Marital Status Select Married Single Divorced Separated Widowed

 

Military

Yes
No

 

Date of Birth

Date of Birth :: mm/dd/yy

 

Place of Birth

 

Social Security Number

Social Security Number :: xxx-xx-xxxx

 

Spouse's Name:

 

Marriage Date:

 

Place of Marriage:

 

Family History

 

Father's Name

Father's Name :: If Unknown, write 'unkown'

 

Father's Place of Birth

 

Mother's Maiden Name

 

Mother's Place of Birth

 

No. of Children:

 

No. of Grandchildren:

 

No. of Great-Grandchildren

 

Residential Information

 

Street Address:

 

City:

 

State: Select One AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

 

Zip Code:

 

Country:

 

Education/Work Experience

 

Highest Education: Select One High School Diploma GED Associates Bachelors Master PhD Some College Other

 

Name of School:

 

School Location:

 

Primary Occupation:

 

Notifications & More

 

Full Name:

 

Relationship: Select One Spouse Parent Child Grandchild Sibling Relative Friend Co-Worker Business Associate Other

 

Phone Number:

 

Action:

Notify
Survivor
Preceded in Death

 

Service Preferences

 

Visitation For: Choose Option Family & Friends Family Only

 

General Service Information

 

Type of Service: Select One Private Public

 

Place of Service: Select One Place of Worship Other

 

Enter Address of Service

 

Street Address:

 

City

 

State Select One AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

 

Service Leader:

 

Casket Bearers

 

Enter Information on the Music you would like to have

 

Music:

 

Check all that Apply

I Will Supply CDs
Performances
Sung
Played

 

Select the Readings that You Want to be Read Aloud at Your Service

 

Readings:

 

Indicate your Preferences for Flowers and Flower Color, if Any

 

Flower Types:

 

Flower Colors:

 

Final Disposition

 

Final Disposition:

Ground Interment (burial)
Mausoleum Entombment (above-ground burial)

 

Does your plan include a graveside/committal service?

Yes
No

 

Enter Mausoleum Address Information, if applicable

 

Mausoleum Name:

 

Street Address:

 

City:

 

State State AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

 

Owner's Name:

 

Please enter the specific location of the Cemetery Plot, crypt or niche

 

Location:

 

Special Instructions:

 

Instructions Regarding Jewelry, Wardrobe and Glasses

 

Clothing Instructions:

 

Primary Person to Finalize all Agreements at Time of Death

 

Full Name:

 

Relationship: Select One Spouse Parent Child Grandchild Sibling Relative Friend Co-Worker Business Associate Other

 

Street Address:

 

City:

 

State: Select One AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

 

Phone Number:

 

Secondary Person to Finalize all Agreements at Time of Death

 

Full Name:

 

Relationship: Select One Spouse Parent Child Grandchild Sibling Relative Friend Co-Worker Business Associate Other

 

Street Address:

 

City:

 

State: Choose Option AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

 

Phone Number:

 

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