Pre-Arrangement Form
"The option that relieves the burden from your family"

One of the most loving, caring things that an individual can do is leave behind details and information in regard to Pre-Planning. 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-Planning will express your wishes.
  • Pre-Planning relieves your family from making difficult decisions at a time of emergency.
  • Pre-Planning will give you and your family the security and satisfaction knowing that all the arrangements have been planned and paid for.
  • Pre-Planning discounts for complete funeral packages save you money.
Reinsel Funeral Home & Crematory is independently owned
and not affiliated with any cemetery or national chain.
If you are ready to begin the Pre-Planning process,
give us a call at 814.677.3049, or fill in the form below.
Personal Information
Name
(First MI Last):
Marital Status:   Social_Security #:
Date of Birth: Place Of Birth:
Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Place of
Marriage: 		Date of Marriage:
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: Rank At Discharge:
Date Discharged: 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:
List any other significant relatives:

Special Instructions
Lodges and Organizations:
Jewelry:
Glasses:
Lodge / Union:
Person in Charge of Final Arrangements:
Clothing Preference: My own Other


Disposition Request
I Prefer:
Cemetery:
Address: Phone:
Section:
I have made a last will and testament:     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