Online Pre-planning Form

hearse

Thomas E. Burger Funeral Home, Inc.

735 East Avenue Hilton, New York 14468	Phone: (585) 392-7100 Fax: (585) 392-4017
E-Mail: info@burgerfuneralhome.com

Online Pre-Arrangement Form

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral ceremony a personal tribute and assures your family that the service reflects your true wishes.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion when emotional stress make decisions difficult.

Because we realize individual wishes and situations are personal, we want to assure you of our high respect for complete confidentiality. We welcome the opportunity to meet personally with you and your family to discuss our services and your options more fully…or simply to answer questions. Or, you may prefer to file the necessary vital statistics and preferred funeral information with us on-line by filling in the following information:

Personal Information
Name (First, MI, Last):
Marital Status:		Social Security#:
Date of Birth:		Birth City & State
Race:		Hispanic/Haitian Origin:
Came to New York area: (year)		From: (City/State)
Residence Address:
City:		State:
County:		Zip:
Phone:		E-mail:
Spouse's Name:		Spouse's Maiden Name:
Spouse's SS#		Place of Marriage:
Date of Marriage:		Father's Name:
Mother's Name:		Mother's Maiden Name:

Work/Education History
Education(0-12):		College 1-5+:
Occupation:
Business:		Company:

Military Record
Branch of Service:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Discharged:		Discharge On File At:
Copy of Discharge Papers:YesNo
Name Of Wars:

Funeral Service Request
Church/Other:
Address:		Phone:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
Address:
City:		State:
County:		Zip:
Phone:		E-mail:

Special Instructions
Flower Preference:
Music
Casket Bearers (6): (leave blank if funeral staff to perform)
Jewelry:
Glasses:
Clothing:
Other:

Disposition Request
I Prefer:
Cemetery:
Address:		Phone:
Property Description:
I have made a last will and testament:YesNo
Location:

Memberships/Affiliations

Other Instructions

Memorials/Donations To Charity

Please select one of the options below
Send information about pre-arrangement Contact me to set an appointment Please keep my information on file

HOME PAGE

OUR HISTORY

OUR SERVICES

OUR FACILITIES

OUR LOCATION

OUR STAFF

Thomas E. Burger Funeral Home, Inc.

MENU

Online Pre-Arrangement Form

Personal Information

Work/Education History

Funeral Service Request

Special Instructions

Disposition Request

Memberships/Affiliations

Other Instructions

Memorials/Donations To Charity

Please select one of the options below