Daniel Funeral Homes

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Pre-Planning Online Form

Control unnecessary expense...achieve peace of mind...pre-plan!

If you are ready to start specifying the details of your funeral services, fill out the following form. Upon filling out this form, Daniel Funeral Home will have a record of your desired arrangements, allowing you to celebrate the life of the deceased, not to worry about all the details of the funeral. We keep this information as a record to better serve you when the time comes, this is not a binding agreement.

If you have any questions, contact us today online or call: 800-358-3313.

Arrangements For Full Name:
Address:
Address (cont):
City:
State:
Zip Code:
Phone:
Birthdate:
Birthplace:
Usual Occupation:
Education Grade Level:
Father:
Mother:
Mother's Maiden Name:
Veteran:

Yes

No

Marital Status:

Married

Widowed

Divorced

Never Married

Marriage Date:
Marriage Place:
Spouse:
Wife's Maiden Name:

Contact Information Contact Person:
Email:
Address:
Address (cont):
City:
State:
Zip Code:
Phone:

Service Preferences Disposition Preference:

Burial

Cremation

Entombment

Other

Other:
Service to be held at:

Funeral Home

Church

Chapel

Graveside

Preferred Church:
Preferred Officiant:
Visitation:

Yes

No

Casket:

Open

Closed

Participating fraternal, military or service organization:

Other Details Obituary:

Yes

No

Newspaper(s):
Survivors:
Pallbearers selected by:
Casket:
Vault:
Flowers (type):
Favorite literature or religious passage/verse:
Favorite musical selection:
Specific requests to be performed at service:
Contributions (Name of charity):
Flag (If Veteran):

Folded

Draped

Given to:
Specific Clothing:
Glasses:
Jewelry:
Cemetery property owned:

Yes

No

Cemetery:
Location: - Space - Lot - Vault - Marker
City:
State:

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