Your Name*

Address*

City*

State*

Zip*

Phone 1*

Phone 2*

Email*

Are you a member of this church?*

Name of Deceased*

What was the death date?*

Was the deceased a member of this church?*

Proposed Funeral Date*

Proposed Funeral Time*

How many people are you expecting for the reception?

Funeral Home Name*

Funeral Director's Name*

Address*

City*

State*

Zip*

Phone 1*

Phone 2*

Email*

Do you need a minister to perform the funeral?

Do you need a musician for the funeral? *

Do you need special music for the funeral?*

Do you desire to have the reception at the church? *

Who will cater the reception?*

Caterer’s Phone #