Online Arrangement Form (Planning Ahead) 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.Contact Person InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Cell PhoneWork PhoneBiographical InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sex*MaleFemaleSocial Security Number The SSN is required to complete the arrangements. If you don't feel comfortable entering the information here, we will call you by telephone to retrieve the SSN.Date of Birth* MM slash DD slash YYYY Birthplace: City, State, Country* Marital Status*MarriedNever MarriedWidowedDivorcedName of Spouse (maiden name, if wife) Spouse's Maiden Name: Survivors' Names and Cities of Residence Relatives Who Have Preceded In Death Usual Occupation* Kind of Business/Industry* Company Name: Church Membership: Lodge or Union Name: Parental InformationLegal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.Father's Name* First Middle Last Father's City of Residence:* Mother's Name* First Middle Last Maiden Mother's City of Residence: Military RecordIn Armed Forces*YesNoBranch of Service:*NoneArmyNavyAir ForceMarinesCoast GuardNational GuardSerial Number:* 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:*PeacetimeWorld War IWorld War IIKorean WarVietnam warPersian Golf WarMilitary Honors at Graveside:*YesNoFlag Preference for Service:*Drape Casket With FlagFolded Flag on CasketPhoneThis field is for validation purposes and should be left unchanged.
