Bliley Funeral Homes Richmond Virgina

More is learned about loss through experience than through preparation. Preparing for anticipated death may be hard for those left behind, but knowing that a loved one's last wishes was carried out with your help may be the best way of coping with their death.

Ask yourself:

Living with a fatal illness has all kinds of costs: emotional, spiritual, physical and financial. You will gain peace of mind knowing your family and friends will be relieved of the emotional and financial stress often associated with making arrangements when a death occurs. By pre-arranging your funeral services, you benefit by purchasing at today's prices, free from inflationary pressures in the future.

Also, see our Pre-Planning Cost Worksheet

"You cannot plant an acorn in the morning and expect that afternoon to sit in the shade of an oak." - Antoine de Saint-Exupery

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Information about person completing the form:
I am Planning for:
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Vital Information about the person you are planning for:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security#:
Date of Birth:	(ex. 1999)
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:	(ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:
Education:
Usual Occupation: (most of life)
Kind of Business:
Company (Optional):

Military Records:
Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers: YES NO
Name Of Wars:

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 is information is the same as person filling out this form

Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Special Instructions:
Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:

Disposition Options:
I Prefer:
Cemetery:
Address:
Phone:
Section:
I have made a last will and testament: YES NO

Other Information & Special 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:

Please select one of the options below:

Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file