Online Arrangements If someone has passed away and you need immediate service, please call 1 (800) 937-1728. We have put together this form for those that want to prearrange funeral services with Hantge Funeral Chapels. Please complete the form to the best of your ability and click Submit. Step 1 of 7 14% Arrangement ForFull Name*Please enter First, Middle and Last NameNickname(if applicable)AddressApartment # or P.O. Box #CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodeTelephone Number Vital StatisticsDate of BirthCity of BirthMother's Name (including maiden name)Father's NameEducationPlease choose a levelElementarySecondaryCollege EducationChoose highest level completed.School Name and CityLast Year CompletedSelect the last year completed1234567891011121314Baptism DateBaptism PlaceConfirmation DateConfirmation PlaceMarital StatusSelect marital statusMarriedDivorcedWidowedSingleSpouse's Name (including maiden name)Marriage DateMarriage LocationResidence History Usual OccupationIndustryEmployers (name of company and city)Date of RetirementService Organizations/Memberships Hobbies/Retirement Activities Survivors - Please use full name and city of residenceSpouseChildren Grandchildren Parents/Sibilings Preceded in death byParentsSpouseChildren Siblings Military RecordsVeteranWas this person a vet?NoYesBranch of ServiceSelect branch of serviceArmyNavyAir ForceMarinesCoast GuardNational GuardDate EnlistedDate of DischargeCopy of DD214 (Discharge) EmailedNoYesCopy of DD214 (Discharge) MailedNoYesMilitary HonorsNoYesMilitary MarkerNoYesFlag PreferenceFoldedDrapedNo Flag Service PreferencesPerson in Charge of Arrangements(Legal Next of Kin)Place of ServiceFuneralChurchGravesideNo ServiceChurchClergy OfficiatingPallbearers Enter up to 8 names here.SoloistNoYesPerson SingingSong for SoloMusical Selections ScriptureEulogyNoYesPerson giving EulogyFlowersFamily OrdersFuneral Chapel OrdersType and color of flowers JewelryNoneRemove and Give to FamilyLeave Jewelry OnGlassesNoneLeave OnGive to FamilyDonate to LionsPublic ViewingNoYesLocation of VisitationPrivate ViewingNoYesCremationNoYesUrn PreferenceSelect an UrnWoodMetalMarbleOtherCasket PreferenceSelect a CasketBronzeCopperStainless SteelWoodMetalDispositionSelect DispositionCemetery BurialMausoleumTake Home CremainsOuter Burial ContainerSelect a Burial ContainerBronze TriuneCopper TriuneStainless TriuneCameo RoseVeteranVenetianContinentalThe SaluteMonticelloGrave BoxName of CemeteryCemetery LocationThe Cemetery Property is in the name ofIs there a marker or monument on the grave?NoYesMiscellaneous Notes and Instructions Contact Information for Person filling out formFull Name*Please enter First, Middle and Last NameAddressApartment # or P.O. Box #CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodeTelephone NumberEmail Address Email Address Again Please contact me to schedule an appointmentNoYes
