Garland Funeral Home

Pre-Need

 

Pre-Need
Please complete the form below to request more information. All information submitted is kept confidential, and in respect to your privacy, only your email address is required information. Any contact information that you provide will not be distributed to any other business or vendor.

First Contact Information

Name:
Address: City:
Phone: Email:
State: Zip:
Place of Birth
Occupation:
Social Security Number: *This is just for our records and is not shared with outside resources
Marital Status:
Spouse's Name:
Date of Marriage:
Place of Marriage:
Spouse's Maiden Name:
Father's Name:
Mother's Maiden Name:

VETERAN AFFAIRS

Branch of Service:
War Served In:
VA Serial Number:
Date of Enlistment:
Place of Enlistment:
Date of Discharge:
Rank at Time of Discharge:
Place of Discharge:

EMPLOYMENT INFORMATION

Usual Occupation:
Business Type:
Employer:
Address:
City & State:
Length of Employment:
Retire Date:

SURVIVORS

Spouse:
Number of Children:
Names of children (spouse) City & State: (Separate by comma)

Names of Grandchildren: (Separate by comma)
Number of Great Grandchildren: (Separate by comma)
Number of Brothers/Sisters
Preceded in death by: (Separate by comma)

EDUCATION

High School:
Date Graduated:
College:
Highest Grade Completed:
Degrees Obtained:

AFFILIATIONS

Church Affiliation:
Church Name:
Address: City: State:
Organizations, Clubs, Lodges, Hobbies, Etc. (Separate by comma)

PERSONAL PREFERENCES & REQUESTS

Person in Charge of Arrangements:
Clergy (Name)
Pallbearers Names: (Separate by commas)
Type:
Preferences & Special Requests:
Memorials:
Location of Funeral:
Newspapers for Obituary:

CEMETARY INFORMATION

Name of Cemetery:
Other Location:
City: State:
Section:
Row:
Lot:
Space:
Is there a monument in place: View Garland Monuments
Garland Monument order#:

SHEET MUSIC / READERS

Organist:
Vocalist:
Song Selections (Separate by comma)
Eulogist:
Reader:

CONTACT PERSON

Name:
Address:
City:
State:
Zip:
Phone:
Email:

Please bring Photos and Clothing for Burial

Comments:

  


 

 

A Tradition of Neighborly Service



Garland Funeral Home
14733 IL HWY 92
Walnut, IL 61376
815-379-2010

 
 
© Copyright 2006, Garland Funeral Home