Pre-arrangement Form

Please take a few minutes to fill out the Online Pre-arrangement form below. Once the information is submitted, a Porter Loring representative will review and file it and will be in touch with you to further discuss the details of your arrangements. If you’d prefer, a printer-friendly version of this form it is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link, if interested.

NOTE: We do not release any information to outside parties under any circumstances.

Information About the Person Completing this Form
Your First Name:
Your Last Name:
Your Middle Name:
Your Email:
Your Street Address:
Your City:
Your County:
Your State:
Your Zip Code:
Your Phone:
I am Planning For:
Vital Information About the Person for Whom Pre-arranging Is Being Done
Last Name:
First Name:
Middle Name:
Gender:
Marital Status:
Social Security #:
Date of Birth:
Place of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Mother's Name:
Mother's Maiden Name:
Father's Name:
Work and Education Information
Education (Primary):
College (1-5+):
Usual Occupation (Most of Life):
Kind of Business:
Company:
Military Records:
Serial Number:
Date Enlisted:
Rank at Discharge:
Discharge on File at:
Copy of Discharge Papers?:
Please list any wars:
Funeral Service Information
Place of Service:
Name of Funeral Home:
Funeral Home Address:
Funeral Home Phone:
Place of Visistation:
I prefer services to be:
Viewing for Family:
Viewing for Friends:
Religious Denomination:
Place of Worship:
Lodge/Union:
Person(s) to finalize arrangements at Time of Death:
Check here and skip this section if information is the same as person filling out this form:
Name:
Address:
City:
State:
Zip:
Phone:
Special Instructions:
Flower Preference:
Music:
Casket Bearer 1:
Casket Bearer 2:
Casket Bearer 3:
Casket Bearer 4:
Casket Bearer 5:
Casket Bearer 6:
Jewelry:
Glasses:
Clothing:
Disposition Options
I prefer:
Cemetery:
Cemetery Address:
Cemetery Phone:
Section:
I have made a last will and testament:
Other Information and special instructions:
Memorials & Charities
Please list any Memorials or Donations to Charity that you would like:
Contact Options:
Send information about pre-arrangement:
Contact me to set an appointment:
Please keep my information on file:

 

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