Parthemore Pre-Planning Worksheet

My Personal Information
(note: asterisks indicate required information)

*First Name:

Middle Name:

*Last Name:

*Date of Birth: Birthplace:

I am a veteran of the military: YES   NO

Address:

City: State: Zip Code:

*Phone: Email:

*Best time to be contacted:

My Choices for My Memorial Service

Selection of burial or cremation:

Cemetery Selection:

Special requests for personalizing the service:

Selection of clergy or rabbi:

Selection of individuals to speak at the service:

Selection of religious readings/scriptures/quotes:

Preference for music to be played:

Military honor details:

Selection of casket bearers:

In lieu of flowers, memorial contributions may be made to: