Reed & Hall Mortuary Corp Quincy, FL
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Contact Us: (850) 627-5700
Online Pre-Planning Form
    Preplanning your funeral demonstrates just how much you care. You relieve your family of having to make important financial decisions during a period of great stress and grief. Funeral pre-planning has become a standard business procedure which should be considered in the same category as making a will, purchasing life insurance and funding higher education.

Pre-need arrangements may involve any or all of the following:
  • Providing funeral instructions 
  • Recording vital statistics 
  • Selecting merchandise and services 
  • Establishing the method of payment 

​I am planning for:   

                                        Personal Informaiton

                                                                                   Name: 

                                                                      Email Address:

                                                                                Address:   

                                                                        City/Province:                                                      State                                 Zip

                                                                                   Phone:

                                                                         Date of Birth:

                                                                        Place of Birth:

                                                                                       Sex:            Male                        Female   
​    
                                                                            Citizenship:
​                                                   
                                                                        Marital Status: 

                                                        Spouse (Maiden Name):    

                                                                         Father Name:                                                                 Birthplace:                                                

                                                         Mother's Maiden Name:                                                                 Birthplace:

                                                                Physician's Name:                                                            

                                                            Religious Preference:

                                            Education

                                                                    High School Name:        

                                                                  #  of Years Attended:

                                                                           College Name:                                

                                                                   # of Years Attended:

                                           Military Status
​                                                       
                                                                    Branch of Service:

                                                                        Service Number:

                                                                            Date Enlisted:                                    Place Enlisted:

                                                                       Date Discharged:                                    Place Discharged:

                                                                     Rank at Discharge:

                                                                  Discharge on File At:

                                                                           Combat Action:


                                                                        Medals / Badges:



                                           Informant / Next of Kin

                                                                                         Name:                                                                    Phone:

                                                                                     Address:

                                                                                            City:                                                State:                                Zip:

​                                          Family Information 

                                          Please list the names of survivors and state their relationship to you, their spouse's names and the city in which 

                                          they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) 

                                          SURVIVORS: Spouse, Sons, Daughters, Parents, Brothrs, Sisters, Grandchildren,  (Great-grandchildren), 

                                          Grandparents, Others (Ex. Son: Robert Jones and his wife Grace of Clearwater)

                                                                                   Survivors:  





                                                                Preceded in Death by:  





                                                                Additional Information:



                                                                Clubs / Organizations:

                                             
                                            Work History 

                                                                                Occupation:                                                      Company:

                                                                                     Industry:                                                      Number of Years:  



                                            Funeral Preferences 

                                              I prefer my Funeral Service to be: 

                                                                                                    Public:                                                      Private:  

                                                                                    Visitation:

                                                                                                    Public:                                                      Private:  

                                                                         Place of Service:  

                                                                                                    Church:                       Name of Church:    

                                                                                                    Cemetery:                   Name of Cemetery:

                                                                                                    Chapel:                       Other:      

                                                                    Place of Disposition:

                                                                                                    Cremation:  

                                                                                                            Burial:                                                                            

                                                                                                 Entombment:  







​                                            
                                                               
                                                          
116 West Jefferson Street ~ Quincy, FL 32351 ~ (850) 627-5700 ~ (850) 627-5702 Fax
"There when you need us the MOST ~ to Love, to Care, to Help"

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