Ivie Funeral Home

Ivie Funeral Home Obituaries

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IVIE FUNREAL HOME ONLINE
PRE-ARRANGEMENT FORM
(THeRE ARE NO FEES ASSOCIATED WITH THIS FORM)

If you prefer to not fill out the whole form,
at least place your name and a way to contact
you so we can set up further arrangements.

Thank you.

Personal Information

I am Planning for:
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Whom you are planning for

Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
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 & Education

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

Military Service

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

Place Of Service:
Name of Funeral Home:
Address:
Phone:
Place of Visitation:
I Prefer The Funeral Service To Be:
Viewing For Family:
Viewing For Friends:
Religious Denomination:
Place Of Worship:
Lodge / Union:

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:

Disposition Options

I Prefer:
Cemetery:
Address:
Phone:
Section:

Other Information or 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:

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