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Clearwater | 620-584-2244    

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Haysville | 316-522-6228    

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Pre-Arrangements Form

Use this form to provide us with as much or as little detail as you wish.  At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Pre-Arrangement Details

Funeral Arrangements for:

Usual Residence of applicant:

Disposition

Service Information:

Veteran’s Burial:

Please list family members in the order of their birth, from first to last, as outlined below:

FULL NAMES OF CHILDREN
(Including stillborn)

MAILING ADDRESS (or DECEASED)

FULL NAME OF BROTHERS AND SISTERS
(Including yourself and any stillborn, in birth order, please)

CITY & STATE (or DECEASED)

Music

Overtime Charges for weekends and holidays
Some Cemeteries and Vault Companies charge for overtime prices on weekends and holidays. Theseprices will vary between each Cemetery and Vault Company. The Mortuary does not have weekendovertime charges.

Cash Advance Items:
Cash Advance Items are items that can be taken care of by the Mortuary for the family.

These items include:

Typical Charges
(These charges are as of January 2011 and are subject to change)

Number of Death Certificates

$15 each certificate ordered (as of January 2010)

Minister/ Priests

$125-$200

Altar Servers

$10 each

Musicians

$100 each

Newspapers

$75-$600+ ($50 charge to add photo) Average charges

Cemeteries

Opening/Closing prices vary at each Cemetery

Hairdresser

$25

Sound Tech

$50-$100

Please provide the following information for an obituary:
Give a chronological summary of your life from birth, including:

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