Preplan Online

Online Preplanning Form

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WHO WOULD YOU LIKE US TO CONTACT

Name

Phone Number

Email Address

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PERSONAL INFORMATION

Please complete the following form with information about the individual for whom it is intended

Who is this plan for?

First Name

Middle Name

Last Name

Address

Date of Birth

Birth Place

Gender

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FAMILY INFORMATION

Father's First Name

Father's Last Name

Mother's First Name

Mother's Maiden Name

Marital Status

Spouses Name

Spouses Phone Number

Date of Marriage

Place of Marriage

If deceased, date of passing

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ADDITIONAL FAMILY MEMBERS

Children

Children (deceased)

Grandchildren

Grandchildren (deceased)

Great-Grandchildren

Great-Grandchildren (deceased)

Siblings Name

Siblings (deceased)

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EDUCATION HISTORY

Education Level

School Name

School Location

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WORK HISTORY

Occupation (if retired, place of occupation before retirement)

Company Name

Years At Company

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MILITARY INFORMATION

US Veteran?

Branch of Military Service

Years served under military service

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ARRANGEMENTS

Church

Cemetery

Visitation Options

Funeral Service Option

Reception Options

Would you prefer burial or cremation?

Final Disposition

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

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

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

Free Text

A representative from the Funeral Home will be reaching out to you shortly.

Online Preplanning Form

Free Text

WHO WOULD YOU LIKE US TO CONTACT

Name

Phone Number

Email Address

Free Text

PERSONAL INFORMATION

Please complete the following form with information about the individual for whom it is intended

Who is this plan for?

First Name

Middle Name

Last Name

Address

Date of Birth

Birth Place

Gender

Free Text

FAMILY INFORMATION

Father's First Name

Father's Last Name

Mother's First Name

Mother's Maiden Name

Marital Status

Spouses Name

Spouses Phone Number

Date of Marriage

Place of Marriage

If deceased, date of passing

Free Text

ADDITIONAL FAMILY MEMBERS

Children

Children (deceased)

Grandchildren

Grandchildren (deceased)

Great-Grandchildren

Great-Grandchildren (deceased)

Siblings Name

Siblings (deceased)

Free Text

EDUCATION HISTORY

Education Level

School Name

School Location

Free Text

WORK HISTORY

Occupation (if retired, place of occupation before retirement)

Company Name

Years At Company

Free Text

MILITARY INFORMATION

US Veteran?

Branch of Military Service

Years served under military service

Free Text

ARRANGEMENTS

Church

Cemetery

Visitation Options

Funeral Service Option

Reception Options

Would you prefer burial or cremation?

Final Disposition

Would you prefer to include a graveside/committal service?

Free Text

YOUR PREFERENCES

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

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

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

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

Free Text

A representative from the Funeral Home will be reaching out to you shortly.

Online Preplanning Form

Free Text

PERSONAL INFORMATION

Who is this plan for?

First Name

Middle Name

Last Name

Address

Date of Birth

Birth Place

Gender

Free Text

ABOUT YOU

Email Address

Phone Number

Free Text

FAMILY INFORMATION

Father's Name

Father's Address

Mother's Name

Mother's Maiden Name

Mother's Address

New Field:

If deceased, date of death

Place of Marriage

Date of Marriage

Free Text

ADDITIONAL FAMILY MEMBERS

New Field:

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Free Text

EDUCATION HISTORY

School Name

New Field:

School Location

Free Text

WORK HISTORY

Occupation

Company Name

Years At Company

Did this person serve in the military?

Branch of Military Service

Years served under military service

Free Text

YOUR WISHES

Church

Cemetery

Visitation Options

Funeral Service Option

Reception Options

Would you prefer burial or cremation?

Final Disposition

Would you prefer to include a graveside/committal service?

Free Text

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 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.

Online Preplanning Form

Online Preplanning Form

Online Preplanning Form

Online Preplanning Form

A Year of Grief Support

Buffalo