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Pre-Arrange Online

Many people do not understand the importance of a pre-planning a service. Take a moment and think if a pre-planned funeral service would spare your family additional stress and burdens associated with your death. We believe the best way is to listen to your concerns and provide the choices you request. Whether you have questions concerning the entire funeral service, cemetery requirements, government or insurance benefits, our staff is available to help you with these issues. By making decisions in advance, which will be more difficult later, you can provide peace of mind to yourself and your family--knowing that everything is taken care of. Please take a few minutes to complete our on-line pre-need form.


I. Biographical Information
Full Name:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will 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:

II. Military Record
Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. 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


 

3700 Glenmore Ave., PO Box 11280 | Cincinnati, OH 45211 | Phone: 513-661-6200 | Fax: 513-661-7286 | Email: info@rebold.com
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