"The option that relieves the burden from your family"

One of the most loving, caring things that an individual can do is to leave behind details and information in regards to Pre-Arranging. If you feel it is too hard to discuss funeral arrangements at this time, just think how difficult it would be for your loved ones at a time of loss.

Advantages of Planning Your Funeral Arrangements

Pre-Arranging will express your wishes.
Pre-Arranging relieves your family from making difficult decisions at a time of emergency.
Pre-Arranging will give you and your family the security and satisfaction knowing that all the arrangements have been planned and paid for.
Pre-Arranging for complete funeral packages save you money and gives you peace of mind.

If you are ready to begin the Pre-Arranging process,
please call Ford Funeral Home at (304) 842-2511
or complete the form below.

Personal Information
Name (First MI Last):
Marital Status:
Birth Date:		Birth Place:
Current Address:
City:		State:
Zip:		County:
Phone:
E-mail:
Spouse's Name:
Spouse's Maiden Name:
Marriage Date:		Marriage Place:
Father's Name:
Mother's Name:
Mother's Maiden Name:
Person in Charge:
Address:
Phone:
Work/Education History
Education (0-12):		College 1-5+:
Occupation:
Business:		Company:
Military Record
Branch of Service:
Serial Number:
Date Enlisted:		Date Discharged:
Rank At Discharge:
Discharge On File At:
Copy of Discharge Papers:		Yes No
Name Of Wars:
Funeral Service Request
Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Newspaper Information (Please list family members)
Children:
Brothers/Sisters:
Number of Grandchildren:
Other significant relatives:
Special Instructions
Lodges and Organizations:
Jewelry:
Glasses:
Lodge / Union:
Clothing Preference:		My own Other
Disposition Request
I Prefer:
Cemetery:
Address:
Phone:
Section:
Last will and testament exists:		Yes No
Location:

Other Instructions
Memorials/Donations To Charity
Please select all that apply: Send information about pre-arrangement Contact me to set an appointment Please keep my information on file