Pre-Planning Questionnaire

One of the most caring, loving things you can do for your family is to make your funeral wishes clear, removing that burden from their shoulders.

 

When the funeral and payment have been arranged in advance, you save your loved ones the uncertainty and confusion of making decisions at an emotionally stressful time.

 

You can get started by submitting the information below and our pre-need director Bruce Swan will quickly be in touch to continue with the process.  If you would prefer to talk with Bruce directly, he can be reached at 843.722.8371 or Rebecca Imholz.

Note: The information below is kept in the strictest confidence. The amount of personal information requested may seem excessive, but it is necessary we have it on file in order to quickly complete the death certificate application.

 

Biographical Information
Full Name:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (mm/dd/yyyy)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: We will obtain your SSN when we contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded You In Death
Your Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

Military Record
Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (mm/dd/yyyy)
Date of Discharge: (mm/dd/yyyy)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information on funeral planning

Please contact me to schedule an appointment

Please place my information on file