On-line Pre-arrangement Form

There are numerous benefits to pre-arranging a funeral, some of which include:

  • Provides peace of mind
  • Relieves your loved ones of unnecessary concern
  • Reflects your expressed wishes
  • Alleviates financial burden on your family

Please take a few minutes to fill out the Online Pre-arrangement form below. Once the information is submitted, a Whitley's Funeral Home representative will review and file it and will be in touch with you to further discuss the details of your arrangements.

Information about the Person Completing this Form:
*First Name:
*Last Name:
Middle Name:
*Email Address:
Street Address:
City:
Country:
State:
Zip Code:
Phone:
Person for Whom I Am Pre-arranging:
Vital Information about the Person for Whom Pre-arranging Is Being Done:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security #::
Date of Birth:
Place of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Father's Full Name:
Mother's Name:
Mother's Maiden Name:
Work and Education:
Education:
Usual Occupation: (most of life)
Kind of Business:
Company:
Military Records:
Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers:
Name(s) of War(s) / Conflict(s) Toured:
Funeral Service Information:
Place of Service:
Name of Funeral Home:
Address:
Phone:
Place of Visitation:
I Prefer the Funeral Service To Be:
Viewing for Family:
Viewing for Friends:
Religious Denomination:
Place of Worship:
Lodge / Union:
Person(s) to Finalize Arrangements at Time of Death:
Check here and skip this section if the person filling out this online form is also the person making the final arrangements.
Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Special Instructions:
Flower Preference:
Music:
Casket Bearers:
1)
2)
3)
4)
5)
6)
Jewelry:
Glasses:
Clothing:
Other:
Disposition Options:
I Prefer:
Cemetery:
Address:
Phone:
Section:
Zip Code:
I Have Made A Last Will And Testament:
Other Information & Instructions:
Please list any other instruction or information you would like us to have:
Memorials & Charities:
Please list any memorials or donations to charity that you would like to declare:
Options:
Please select one of these options: