Prearrangement Form

Prearranging your funeral is one of the most considerate, compassionate things you can do for your family. It saves them the burden of having to make complex choices and arrangements at a most difficult time. If you simply wish you make your choices in advance and keep them on file, we are happy to help you with this at no charge.

Please provide the following details and submit.
*Required Information
First Name*
 Middle Name
 Last Name*
Marital Status*
 Date of Birth
Social Security #*
 Place of Birth
Address
 City
State
 Zip
Phone
 Email
Spouse's Full Name
 Spouse's Full Maiden Name
Father's Full Name
 
Mother's Full Name
 Mother's Full Maiden Name
Education
 Occupation
Business
 Company
Branch of Service
 Service Number
Date Enlisted
 Rank at Discharge
Date Discharged
 Discharge on file at
Copy of Discharge Papers:
Yes   No 		Wars and Conflicts
Place of Service
 Place of Visitation
Funeral Home
Whitaker Funeral Home - Newberry
Whitaker Funeral Home - Chapin 		Insurance Information
Religious Affiliation
 Lodge/Union
Person in Charge of Final Arrangements
 Casket Bearers (6 min):
Florist Preference
Desired Jewelry
Wear Glasses
NA   Yes   No
Desired Clothing
I prefer
 Cemetery Name

Section
Other Instructions You Want Us to Know
Send me information about pre-arrangement
Contact me to set up an appointment
Please keep my information on file

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