Pre-Arrange Online

Pre-Arrange Online

A pre-planning information sheet follows. For your convenience, please feel free to provide us with the information that is typically necessary for the various legal and practical needs that arise following death. Once this information is received, we will keep it on file and send to you (or e-mail) a letter of confirmation.

If you wish, you may set up a FREE consultation with one of our licensed Family Service Counselors to meet with you. Please call us at (423) 843-2525.

Information about person completing the form:
I am Planning for:
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Hispanic Origin:

Vital Information about the person you are planning for:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security#:
Date of Birth:	(ex. 1999)
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:	(ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:
Education:
Usual Occupation: (most of life)
Kind of Business:
Company (Optional):

Military Records:
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 Information:
Service Options:
Place Of Service:

Church:
Religious Denomination:
Viewing for Family:
Viewing for Friends:
I Prefer
Name of Cemetery:
City:		State:
Grave or Niche Location:
Click for cremation options.
Favorite Bible Passages, Literature or Poems:

Person(s) To Finalize Arrangements At Time Of Death:
Check here and skip this section if is information is the same as person filling out this form

Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Special Instructions:
Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:

Other Information & Special Instructions
Please list any other instruction or information you would like us to have:

Memorials & Charities
Please list any Memorials or Donations to Charity that you would like:

Please select one of the options below:

Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file

At Legacy Funeral Home and Cremation Center, we take your right to confidentiality very seriously. We will not share information you submit to us with any person or entity outside of our company not legally entitled to receive it.