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Start Planning

Ready to get started? Begin planning here.

Use the form below to start completing necessary paperwork online. You do not have to complete all of it.

At a minimum, please provide your name and telephone number or email address.

Advance Funeral Planning Form

Step 1
Personal Information
Step 2
Family Information
Step 3
Work/Education History
Step 4
Military Record
Step 5
Funeral Service Request
Step 6
Disposition Request
Step 7
Summary Details

First Name*

Last Name*

Phone*

Email*

Street

City

State/Province

ZIP/Postcode

Date of Birth

Place of Birth

Father's Name

Father's Place of Birth

Mother's Name

Mother's Maiden Name

Marital Status

Mother's Place of Birth

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

Additional Family MembersPlease use the area above to enter the names of siblings, children and grandchildren.

Label

Education Level

Grade SchoolHigh SchoolDegreeMasters DegreeDoctorate

Occupation

Company Name

Business Field

Did you serve in the military?

YesNo

Branch of Service

Serial Number

Date Entered Service

Rank at Discharge

Date Discharged

Discharge on file at

Label

Do you have a copy of your discharge papers?

YesNo

Wars Fought In

Person in Charge

Address

Telephone

Place of Service

Telephone

Place of Visitation

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

Person in charge of final arrangements

I Prefer

Cemetery

Lot #(if applicable)

Section/Letter(if applicable)

Grave #(if applicable)

Address

Telephone

I have made a last will and testament

YesNo

Location of Will

Label

Additional instructions for us

Memorial requests or donations to charity

Thank you for the information. How can we best serve you next?

Review pricing and finalize my plans with an advance planning specialist

Keep this information on file until I’m ready to finalize my plans

Anti-Spam Security Question

Label

New Section - add your content below

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Pre-Arrangement Details

Personal Information

Full Name

Street

City

State/Province

ZIP/Postcode

Telephone

Date of Birth

SSN #

Email Address

Place of Birth

Father's Name

Mother's Name

Mother's Maiden Name

Marital Status

Father's Place of Birth

Mother's Place of Birth

Spouse's Name

Place of Marriage

Spouse's Maiden Name

Date of Marriage

Additional Family MembersPlease use the area above to enter the names of siblings, children and grandchildren.

Work/Education History

Education Level

Grade SchoolHigh SchoolDegreeMasters DegreeDoctorate

Occupation

Company Name

Business Field

Military Record

Did you serve in the military?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Discharge on file at

Do you have a copy of your discharge papers?

YesNo

Wars Fought In

Person in Charge

Address

Telephone

Funeral Service Request

Place of Service

Telephone

Place of Visitation

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

Person in charge of final arrangements

Disposition Request

I Prefer

Cemetery

Lot #(if applicable)

Section/Letter(if applicable)

Grave #(if applicable)

Address

Telephone

I have made a last will and testament

YesNo

Location of Will

Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed just keep my request and information on file

Anti-Spam Security Question

Let us help guide you

Your Name*

Email Address*

Subject

Your Message

Anti-Spam Security Question

Contact Us

You are welcome to call us any time of the day, any day of the week, for immediate assistance. Or, visit our funeral home in person at your convenience.

1121 Roberts Avenue
Madera, CA 93637
559-674-8814

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