PRE-PLANNING REGISTRATION

From the privacy of your own home you can select the type of
memorial service that best reflects your lifestyle and personal interests.
Contacting us, you may select your casket and vault in advance.
You may also decide to pay for your funeral in advance, protecting 
against any future cost increases and also serving as a tax shelter.
We have many funding plans available to make your pre-planning
as easy and convenient as possible.


We will maintain a copy of your pre-arrangement requests in
confidence at our homes, and will forward a copy to you for your records.
There are several different areas of information that are important in each
service that we handle. Vital statistics, military involvement, church and
civic memberships, family members, and even your hobbies or special
interests can all be recorded below.  If you have any questions or need
any help with completing any of these areas, please feel free to contact us
at (270) 965-0110


All fields marked with a * are required:
All fields marked with a * are required:
First Name *  
Middle Name *  
Last Name *  
Address *  
City *  
State *  
Zip Code *  
Telephone *  
Email  

Date and Place of Birth City/State or County/State

 
Marital Status  
Spouses Name Maiden or Full Name  
Occupation  
Social Security Number  
Fathers Full Name  
Mothers Full Name Include Maiden Name

Person who will be in charge of my funeral arrangements:

 
Admin Name  
Admin Address  
Admin City  
Admin State  
Admin Zip Code  
Admin Telephone  
Branch of Service  
Description of Service
Veterans Service Number  
Rank  
Location of Discharge Papers  
Spouse
Daughters
Sons
Grandchildren
Sisters
Brothers
Other Relatives
Place of Service Funeral Home, Church, Graveside or other  
Clergy
   

Type of Disposition Entombment

 
Cremation  
Other  
Cemetery Property Owned YES  
Name of Cemetery  
Cemetery Preference  
Music Selections
Pallbearers
Lodge Society Fraternal Organization
Flowers
Memorial Donations
Obituary Information
List education and place of schooling, wedding date and place, work history and places lived,
Clubs, Lodges, Hobbies, Interests, Accomplishments, Community or Private Involvement.
Special Instructions
Please Contact me so that I may select my Casket and Vault  
Please Forward a copy of my info to me  
Please Contact me if info needs clarification  
File my Information for Future  
I would like Pre Payment options