Chad R. Harding, Owner/Licensee-in-charge
 
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PrePlanning

There are three basic steps to Pre-Planning a funeral

Step 1 - Recording Vital Statistics and Personal Wishes
Step 2 - Select Merchandise
Step 3 - Secure Dedicated Funding

You can complete Step 1, by filling out the form below.  When done - choose "Submit" and we will keep it on file for you.  We'll also provided you a copy for your records.  We strongly recommend you store it with your other important papers and official documents.

Please note: the only additional information you will need to provide will be Social Security number, but we don't ask that on this webpage.

Today's Date

Form Submitted by:
Full Name
Address
City   State   Zip
Phone   Email
 
This Information is for:
First   Middle   Last
Current Address
City   State   Zip   County
     
Date of Birth Birthplace
Race   U.S. Citizen
Father's Name Mother's Name (including Maiden)
Marital Status   Spouse
 
Next of Kin:  
Full Name   Relationship
Address
City   State   Zip
Phone
 
Employment Status   Employer   No. of Years
   
Type of Business   Usual Occupation
Education Level
Veteran   Rank   Branch of Service
Service Dates   Service Number
Do you know where your DD214 is?
Honors and Commendations
 
Religion   Church / Parish / Temple / Synagogue
 
Circles, Clubs, Organizations, Fraternal Groups
Hobbies, Favorite Activities
Services to be officiated by
Favorite Hymns and Songs
Favorite Scriptures, Poems, Readings


Type of Funeral Service
Traditional Service with Burial or Entombment
     Visitation One Day / Funeral Service and Committal Next Day
 Combined Visitation / Service / Committal (all the same day)
Direct Burial (no visitation or services)
Traditional Funeral with Cremation
     Visitation One Day / Funeral Service Next Day
 Combined Visitation / Service (all the same day)
 Cremation with Memorial Service only.
 Direct Cremation (no visitation or services)

 

 

 

147 Main St, Poca, WV 25159
(304) 755-1361

514 50th St. SE Charleston, WV 25304
(304)925-4784