Funeral Pre Arrangement Form - Rosetown Funeral Home

Full Name

Phone Number

Address

State/Province

City

Postal/ZIP Code

This Funeral Arrangement is for

Myself Someone Else

Funeral Type

Casket Selection

Custom Painted?

Which Colour?

Viewing

Pallbearers

Flowers For Casket

Existing Plot?

Where?

Instructions For Ashes?

Venue

Celebrant

Song/Hymns To Be Sung At Service (if any)

Music To Be Played At Service (If Any)

Bible Readings/Poems/Literature To Be Read At Service (If Any)

Other Ideas to Make It Personal

Refreshments After Service

Yes No

Donations Made To

RSA To Participate

Yes No

Full Legal Name

Gender

Male Female

Date Of Birth

Place Of Birth

Years Lived in NZ (If not born in NZ)

Address

State/Province

City

Postal/ZIP code

Usual Occupation (Before Retirement)

Ethnic Group

Please write all your children's names and birthdates below:

Mother's Full Name

Mother's Maiden Name

Mother's Occupation

Father's Full Name

Father's Occupation

Marital Status

Spouse's Full Name

Spouse's Maiden Name

Date Of Birth

Date Of Marriage

Place of Marriage

Previous Marriages (if applicable)

Full Name

Relationship

Address

State/Province

City

Postal/ZIP Code

Contact Email

Contact Phone

Name

Company Name

Wording

Where Published

Member Of Armed Services?

Service Number

Country Of Service

Date Of Service

Unit/Regiment

Additional Information

Funeral Pre-Arrangement Form

It’s Hard To Forget Someone Who Gave You So Much To Remember…

Any Questions?