Pre-Planning Form

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Phone: (580) 233-2700--

3002 N. Van Buren

ENID, OK. 73703

(580) 233-2700

Personal information
I am planning for:
Your Name:
Email address:

Person you are pre-planning for.
Full legal name:
Date of birth:	EX: 1/1/2002
Place of birth:
Street address:
City:
State:
Zip code:
Daytime phone:
Evening phone:
Email address:
Sex:	Male Female
Social security number:

Occupations and employers:

Business or industry:

Last position held:
How long at last position:
Retired	Yes No
If retired - then year retired:
Last residence:
Length of time living there:
High school graduated from:
Education:

College’s - years attended and degrees earned:

Hobbies / affiliations / lodges / memberships / church attended / obituary info / etc:


Marital status:
Spouse's full legal name:	(First, middle, last - if wife include maiden name)
Date of marriage:	EX: 1/1/2002
Place of marriage:
If spouse is deceased - then date of death:	EX: 1/1/2002
Father's legal name:	(first, middle, last name)
Mother's legal name:	(first, middle, maiden name)
Mother's maiden name

Veteran's information
Branch of service:
War service and awards:
Enlistment date (if known):
Enlistment place (if known)
Rank at discharge:
Discharge date:
Service number:

Person responsible for funeral arrangements
Name:
Address:
Phone:
Email address for obituary:

Family members:

Please list surviving family members below, name and relationship, including spouse, children, parents, grandparents, brothers, sisters, grandchildren, etc., and city/state where they are currently living.

Predeceased by the following family members:
(name and relationship to deceased)

Service information

Please select one of the following as your preference:

Traditional Funeral Service	Traditional Cremation Service
Graveside Burial Service	Memorial Cremation Service
Immediate Burial	Graveside Cremation Service
	Direct Cremation

Cemetery:

City & State:

Deed in the name of:

Location (Section, Block, lot, Grave No.):

Special instructions:

Services to be held at:
Funeral home
Church / Church name
Other / Specify
Graveside

Clergy:
Musicians:
More Musicians:
Songs:
More Songs:

Memorial contributions to:

Address, where pre-arrangement documents can be delivered: (address, phone, contact)

Please call me Tell me how to pre-pay expenses Please keep my information on file

If you would like to speak with someone at any time, or have questions in regards to the pre-arrangement process or this document, please feel free to contact any of our knowledgeable, friendly staff at (580) 233-2700.

Family Owned and Operated by: Richard & Monte Burris - 3002 North Van Buren, Enid, OK. 73703