Pre-Planning Form

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Funeral Pre-Planning Form

With on-line arrangements, you can take your time selecting the arrangements which are best for your preferences and budget. Explore different options until you find those that are right for you.

This plan is for
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First Name
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Middle Name
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Last Name
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This is your contact information - the person who is filling out this form.

First Name
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Middle Name
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Last Name
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Daytime Phone(*)
Please enter a valid daytime phone number.

Evening Phone
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E-mail(*)
Please enter a valid email address.

 
Biographical information for the person this funeral plan is for.

Birth Date:
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Birth Place
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Family Information

Marital Status
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Father's Name
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Father's Address (if living)
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Mother's Name
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Mother's Address (if living)
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Siblings Living
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Siblings Deceased
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Children Living
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Grand Children Living
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Children Deceased
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Grand Children Deceased
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Great Grand Children Living
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Great Grand Children Deceased
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Education & Work

Highest Level of Education
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School Name
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School Location
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Occupation
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Company
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Years at Company
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Military Service

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Military Branch
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Military Rank
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Years of Military Service (from-to-when)
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Visitation Options

Vistation Location
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Visitation - Other Location - Specify
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I do not wish to have visitation hours
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Funeral Service Options

Funeral Location
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Funeral - Other Location - Specify
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I do not wish to have a funeral service
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Memorial Service Options (only)

Memorial Location
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Memorial - Other Location - Specify
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I wish to ONLY have a memorial service
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Would you like a burial or cremation?

Burial or Cremation
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Final Disposition

Final Disposition

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Graveside Service

Would you prefer to include a graveside/committal service?
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Please list any musical selections you would like to include in your services:
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Please list any poems, religious texts, or readings you would like to be read at your services:
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Please list any interests or hobbies you would like to include in your services:
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Please list any special themes you would like to include in your services:
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Please list any specific foods or beverages you would like to make available to your family and guests at the services:
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Is there a special story, personal thank you, or message of hope you would like to be read during your services?
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Submit Pre-Planning form to Henderson ~ Van Atta Stickle: