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Pre-Arrangements Online Form
Name
Sex
Please Select
Male
Female
Date of Birth
Place of Birth
Address
City
State
Zip Code
Country
Family Information
Spouse's Name
Spouse's Maiden Name
Mother's Name
Mother's Maiden Name
Father's Name
Ancestry
Education / Work History
Occupation
Business or Industry
Education (0-12)
Military Record
Branch of Service
Serial Number
Date Enlisted
Date Discharged
Rank at Discharge
Copy of Discharge Papers
Please Select if Applicable
Yes
No
Name of Wars
Informant
Person to contact at time of death
Contact's Address
Phone
Relationship to deceased
Funeral Service Request
I would prefer to be...
Please Select
Buried
Cremated
Donated to Science
Other
Place of Visitation
Please Select
Stroo Funeral Home
Church
Other
Place of Ceremony
Please Select
Stroo Funeral Home
Church
Other
Name of Church
Clergy to Officiate Ceremony
Special Instructions
Flower Preference
Music
Jewelery
Please Select if Applicable
Bury with Body
Return to Family
Glasses
Please Select if Applicable
Bury with Body
Return to Family
Clothing
Other
Merchandise
Casket
Please Select if Applicable
Wood
Metal
Color or Species of Wood
Verse for the Memorial Folder
Other Information
Other Instructions for Family Members
Memorials / Donations to Charity
Please Select one of more of the options below
Please send me information about Pre-Arrangement
Contact me to set up an appointment
Please keep my information on file
Submit - Thank You
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