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Your Information
Your Name*
Address*
City*
State*
Zip*
Your Phone No 1*
Mobile
Home
Work
Your Phone No 2*
Mobile
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Work
Email*
Are you a member of this church?
Yes
|
No
Funeral Information
Name of Deceased*
What was the death date?*
Was the deceased a member of this church?*
Yes
|
No
Proposed Funeral Date*
Proposed Funeral Time*
Start time
End time
How many people are you expecting for the reception?
Funeral Home Contact Information
Funeral Home Name*
Funeral Director's Name*
Address*
City*
State*
Zip*
Your Phone No 1*
Mobile
Home
Work
Your Phone No 2
Mobile
Home
Work
Email*
Funeral Needs
Do you need a minister to perform the funeral?
Yes
|
No
Do you need a musician for the funeral? *
Yes
|
No
Do you need special music for the funeral?*
Yes
|
No
Do you desire to have the reception at the church? *
Yes
|
No
Who will cater the reception?*
Caterer’s Phone #
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