PRE-NEED



We at Gash Memorial Chapel know how difficult a death in the family is, especially if the family has the added burden of planning the funeral at the time of death.

Our pre-need counselors are specially trained to discuss these decisions with you, and explain all of the options in funeral and cremation services. They will also help with pre-financing, Veterans Benefits, and Social Security benefits.

Preplanning your funeral helps determine your wishes and controls your costs. It is one of the best things you can do for your family.

We now offer on-line pre-planning, please fill in the form below and submit. We will place the information on file for future reference. If you have any questions, please do not hesitate to contact us.


BIOGRAPHICAL INFORMATION:
Name: Age:
Address: Phone:
City: State/Province: Zip:
Occupation:
Place of Birth: Date of Birth:

Veteran?
Yes No War

Marital Status:
Single Married Widowed Divorced

Church Affiliation:

Clubs/Unions/Civic Organizations:


Father: Living? Yes No
Name: First MI Last

Mother: Living? Yes No
First MI Maiden Married

Spouse: Living? Yes No
First MI Maiden Married

Highest Level of Education Attained:

FAMILY MEMBERS ( LIVING ):
Daughters ( Include City & State of Residence & Phone # )


Sons ( Include City & State of Residence & Phone # )


Sisters ( Include City & State of Residence & Phone # )


Brothers ( Include City & State of Residence & Phone # )


Grandchildren: # Great G.C. Great-Great

Preceded in Death By:
Brothers:

Sisters:

Children:


SERVICE INFORMATION:
Type of Service:
Traditional Cremation

Place of Visitation:
Funeral Home Church Other

Place of Funeral:
Funeral Home Church (Name of Church)

Do you prefer special rites:
Military Masonic Knights of Columbus Other

Attending Clergy:
,

Name of Cemetery
City State/Province

Type of Music:
Piano Organ CD Vocalist Instrumental Only

Song Selections:
, ,

Pallbearers ( Minimum of 6, Maximum of 12 ):
, ,
, ,
, ,
, ,

Type of Flowers:

Memorial Photos Displayed? Yes No

Other Personal Requests:


I would like to meet with a counselor to select services, casket and vault.

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