Pre-Plan Online NOW! - Tong & Peryer

1Personal Information

2Family Info

3Education/Work

4Military Service

5Service Options

6Service Requests

7Final Disposition

Name

First Middle Last

Phone

Beneficiary's Personal Information

This plan is for

Name

First Middle Last

Gender

Male

Female

Birth Date

DD slash MM slash YYYY

Birth Place

Marital Status

Single

Married

Divorced

Widowed

Separated

Name of Spouse

Maiden Name of Spouse

If deceased, date of death

DD slash MM slash YYYY

Marriage Date

DD slash MM slash YYYY

Father's Name

Address - If Living

City

State

Zip/Postal Code

Mother's Name

Address - If Living

City

State

Zip/Postal Code

Siblings (Living)

Siblings (Deceased)

Children (Living)

Children (Deceased)

Grandchildren (Living)

Grandchildren (Deceased)

Great Grandchildren (Living)

Great Grandchildren (Deceased)

Highest Level of Education

School Name

School Location

Occupation

Company

Years at Company

Military Service

Yes

Branch of Service

Years Served

VISITATION OPTIONS

Visitation at funeral home.

Visitation at

I do not wish to have visitation hours.

Visitation at

FUNERAL OPTIONS

Funeral service at funeral home.

Funeral service at

I do not wish to have a funeral service.

Funeral service at

RECEPTION OPTIONS

Reception at funeral home.

Reception at

I do not wish to have a reception.

Reception at

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 into your services.

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

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

Burial or Cremation?

Burial

Cremation

Graveside/committal service?

Yes

Disposition Options

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

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Beneficiary's Personal Information