Home Service Details

Your Name (required)

Your Email (required)

Service at
 Funeral Home Church

Church Preference

Clergyman or Reader

Members of Lodges, Church, Club, Union, War Veteran, etc.

Pallbearers selected by
 Family Funeral Home

Honorary Pallbearers
 Yes No


Do you wish a lodge service?
 Yes No

If so, what lodge?


Preference in flowers: Type


Obituary
 Yes No


Name of Cemetery

Lot in name of

Section

Lot

Block

Plot

 Interment Entombment Cremation


Location of Deed

Ship to

City

State

Receiving Funeral Director


Music
 Our Staff Family

Instrumental

Prelude

Postlude

Songs to be sung

Further Instructions

Glasses
 Yes No

Disposition

Jewelry

Clothing

Other


Children (please list name, address and birthdate)

Relatives and Friends to Notify (please list name, address and phone number)