Online Pre-planning Form for Funeral Arrangements

Online Preplanning Form

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PERSONAL INFORMATION

Who is this plan for?

First Name

Middle Name

Last Name

Address

Date of Birth

City and State or Country of Birth

Social Security Number

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ABOUT YOU

Email Address

Phone Number

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FAMILY INFORMATION

Father's Full Name

Mother's Full Name (include maiden name)

Marital Status

Spouse's Full Name (include maiden name)

Place of Marriage

Date of Marriage

Next of Kin Full Name

Next of Kin Phone Number

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ADDITIONAL FAMILY MEMBERS

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Siblings (alive)

Siblings (deceased)

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EDUCATION HISTORY

School Name

Highest Level of Education

School Location

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WORK HISTORY

Occupation

Company Name

Years At Company

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MILITARY SERVICE

Did this person serve in the military?

Yes

No

Branch of Service

If Other, Please Specify

Copy of DD214 Provided

Yes

No

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OBITUARY

Obituary Posted Online

Yes

No

Newspaper(s) Obituary Should Appear In

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YOUR WISHES

Visitation Options

If Elsewhere, Location

Funeral Service Option

If Elsewhere, Location

Reception Options

If Elsewhere, Location

Would you prefer burial or cremation?

Final Disposition

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Cemetery Preference

Lot Purchased

Yes

No

Existing Grave Marker

Yes

No

Special Ceremonies

Would you prefer to include a graveside/committal service?

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YOUR PREFERENCES

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Please list any interests or hobbies you would like to include into your services.

I am a member of the following clubs, groups, church, organizations.

Get in Touch

Online Preplanning Form

Online Preplanning Form

Online Preplanning Form

Eernisse Funeral Homes & Cremation Service

Belgium

Cedarburg

Port Washington

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