Family Service Request

Service Information

Date of Service

Time of Service

Funeral Home

Location of Service

i.e. DFW National Cemetery

Address

Is there a second service? Inurnment or Interment? (i.e. Graveside following Chapel)

If there is more than 3 hrs between services or services are on different days, an additional fee may occur.

Yes

Full Name of Deceased

First Middle Last

Next of Kin Information

Next of Kin/Point of Contact

Relationship to the deceased

Next of Kin Email

Next of Kin Cell Phone

Phone

Other Information

Type of Minister Requested

Please specify if a particular denomination, language, culture or nationality of minister is requested (Christian, Catholic, Spanish speaking, etc).

Additional Information or Comments

Policy Agreements

Payment Policy: Yes, I agree to pay the service honorarium upon submission of this request. We will not complete this request unless payment is receive on the next screen.

The service honorarium for the service you are requesting is $475. This will be the only fee. We will not complete this request without confirmation of payment from the next screen.

Payment Policy: Yes, I agree to pay the service honorarium upon submission of this request. We will not complete this request unless payment is receive on the next screen.

Cancellation Policy: Yes, I understand and agree that a 50% cancellation fee will be assessed for any service cancellation after booking.

Yes, I have checked the form for accuracy before submitting.

Send me a copy of my responses

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