Quinn Funeral Homes

Advance Planning Form

There are numerous benefits to pre-arranging a funeral, some of which include:

Provides peace of mind
Relieves your loved ones of unnecessary concern
Reflects your expressed wishes
Alleviates financial burden on your family

Please take a few minutes to fill out the Online Advance Planning form below. Once the information is submitted, a Quinn Funeral Homes representative will review and be in touch.

If you'd prefer, a printer-friendly version of this form is also available for you to download. CLICK HERE to download.

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Information about the Person Completing this Form:

First Name *: Last Name *: Street Address: City: State: Zip: Email *: Phone: Person for Whom I Am Pre-arranging:

Vital Info about the Person for Whom Pre-arranging is Being Done:

First Name: Last Name: Sex: Marital Status: Social Security #:
Date of Birth:

Place of Birth: Spouse’s Full Name: Spouse’s Maiden Name: Father’s Full Name: Mother’s Name: Mother’s Maiden Name:

Work:

Occupation: Kind of Business:

Veteran:

Are you a veteran?:

Yes No

Funeral Service Info:

Place of Service: Place of Visitation: Religious Denomination: Place of Worship:

Special Instructions:

Flower Preference: Music: Casket Bearers (x6):
1.
2.
3.
4.
5.
6.

Disposition Options:

I Prefer: Cemetery:

Other Information and Instructions:

Please list any other instruction or information you would like us to have:

Memorials & Charities:

Please list any memorials or donations to charity that you would like to declare:

Options:

Please select one of the options below:

Contact Me To Set An Appointment Please Keep My Information On File

Submit