Online At-Need Funeral Planning

Would it be better in your situation to plan ahead, calmly and sensibly, when you are in a normal mental and physical state, when you have full ability to reason, and when you are able to discuss arrangements with your family?

You may file vital statistics and preferred funeral information with us on-line by filling in the form below.

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:	Enter Text Here...
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	Enter Text Here...
Relatives Who Have Preceded You In Death	Enter Text Here...
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):	Enter Text Here...
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:	List Clergy Here...
Pallbearers:	List up to eight pallbearers
Flower Preference:	Enter Flower Preference...
Music Selection:	Enter 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: Enter Text Here...
Please select one of the options below: Please send me information Please contact me to schedule an appointment Please place my information on file

Bartley Funeral Home

Immediate Need

Pre-Arrangement

Obituaries & Tributes

Order Flowers

Online At-Need Funeral Planning

I. Biographical Information

II. Military Record

III. Service Preferences

Obituaries

Search

Bartley Funeral Home

Immediate Need

Pre-Arrangement

Obituaries & Tributes

Order Flowers

Online At-Need Funeral Planning

I. Biographical Information

II. Military Record

III. Service Preferences