Unity Pre-Plan Form

Personal Information
First Name: *
Last Name: *
E-mail: *
Street Address: *
City: *
County: *
State: *
Zip Code: *
Main Phone: *
Vital Statistics
Marital Status:
Date of Birth:
Place of Birth:
Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage
Father's Name:
Mother's Name:
Mother's Maiden Name:
Work/Education
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 Info
Place of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
Special Instructions
Flower Preference:
Music:
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:
Disposition Request
I Prefer:
Cemetery:
Cemetery Addresss:
Cemetery Phone:
Section:
Location:
I have made a last will & testament:

Yes No
Other Instructions
Please list any other instructions you may have:
Memorials / Donations
Please list any Memorials or Donations to Charity that you would like:
Options
Please select one of the options below:

Send information about pre-arrangement Contact me to set an appointment Please keep my information on file
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Personal Information