On Line Pre Arrangement Form 

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral ceremony a personal tribute and assures your family that the service reflects your true wishes.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion when emotional stress make decisions difficult.

Because we realize individual wishes and situations are personal, we want to assure you of our high respect for complete confidentiality. We welcome the opportunity to meet personally with you and your family to discuss our services and your options more fully…or simply to answer questions. Or, you may prefer to file the necessary vital statistics and preferred funeral information with us on-line by filling in the following information:

Personal Information
Name
(First MI Last):
Marital Status:   Social Security#:
Date of Birth: Birth
City & State
Race: Hispanic/Haitian Origin:  
Came to Lake Martin Area in: (year) From: (City/State)
Residence Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Spouse's SS# Place of
Marriage:
Date of Marriage: Father's Name:
Mother's Name: Mother's Maiden Name:
Work/Education History
Education(0-12): College 1-5+:
Occupation:
Business: Company:
Military Record
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Copy of Discharge Papers:    Yes    No
Name Of Wars:
Funeral Service Request
Place Of Service:
Church/Other:
Address: Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
Address:
City: State:
County: Zip:
Phone: E-mail:
Special Instructions
Flower Preference:
Music
Casket Bearers (6):

(leave blank
if funeral staff
to perform)

Jewelry:
Glasses:
Clothing:
Other:
Disposition Request
I Prefer:
Cemetery:
Address: Phone:
Property Description:
I have made a last will and testament:    Yes    No
Location:
Memberships/Affiliations
Other Instructions
Memorials/Donations To Charity
Please select one of the options below
Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file

E-mail us: info@radneysfuneralhome.com