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Bauman Funeral Home

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Pre-need Online Worksheet

Once you have filled in the information you may:
  • Use the submit button on the bottom of this page to send it to us electronically.
  • Print the completed form and mail it for us to keep on file
  • Print the completed form and place it with your important papers
Information about person completing the form
Name
Today's Date
I am planning for
Daytime Phone
Evening Phone
Fax (if available)
email
 
Personal information about person planning for
Name
Sex
education level
date of birth
place of birth
Social Security Number
race
street address
mailing address
city / state /zip
county
length of stay at current address
Is home address within city limits?
Spouse's full name
Spouse's maiden name
Mother's name
Mother's maiden name
Father's name
occupation
kind of business or industry
public activities or fraternal organizations
list hobbies and other interests
 
Military Service
Service Branch
Serial Number
Place Enlisted
Date Enlisted
Place Discharged
Date Discharged
VA Claim or File #
Rank Obtained
   
Funeral Preferences
I Prefer
I Prefer the Funeral Service to be
Place of Service
Name of Cemetery or Preferences of Final Disposition
City / State / Zip
Grave or Niche Location
Religious Denomination
Church Affiliation
Viewing for Family
Viewing for Friends
Musical selections to be played

1.  Will supply CD/Tape
2.  Will supply CD/Tape
3.  Will supply CD/Tape
4.  Will supply CD/Tape

Musical selctions to be sung

1.  Will supply CD/Tape
2.  Will supply CD/Tape
3.  Will supply CD/Tape
4.  Will supply CD/Tape

Favorite Bible Passages
Favorite Literature or Poems
Favorite Flowers
Favorite Flower Color
 
Family Information
Family Members Name
Spouse
Relationship
City
State
   
Person(s) to finalize arrangment at time of death
Name
Relationship
Address
Daytime Phone
Evening Phone
Other Information

Please call me

Tell me how to guarantee expenses

Keep information on file
 
 

 

Home | Afterloss & Grief | Children and Funerals | Pre-need Planning | Funeral Costs

Arranging a Funeral | Consumer Benefits | Obituaries | History | Links | Online Memorials

© 2003. Bauman Family Funeral Homes. All Rights Reserved.
Email bauman@rangenet.com if you have any questions.