Full Service Funeral Home - 115 Church Street / 203.453.3558
Guilford Funeral Home - Sullivan Family Proudly Serving Our Shoreline Area for Over 45 Years

Pre-Arrangement Form

* indicates a required field.

General Questions

Have I ever been responsible for making funeral arrangements?
Yes No

In the event of my death, who would be responsible for making the arrangements?
 My spouse
My son or daughter
More than one of my children
A good friend or neighbor
One or both of my parents
I'm not sure

 The funeral I want would include:
 A copper or bronze casket
A hardwood casket
A steel casket
Cremation with a memorial service
Visitation for friends and relatives
A traditional service or a personalized remembrance
I'm not sure

 The money needed to pay for my funeral would come from:
 My life insurance
My savings
My family's savings
A bank loan taken out by my spouse or family
I'm not sure

 If my death occurred tomorrow, I would regret most regarding my final arrangements:
 The emotional burden it would place on my survivors
No one would know what I wanted for myself or for my loved ones
The financial strain it would cause my survivors
The possibility of emotional overspending
The potential for disagreements among by survivors over what to do
That I had not taken care of it myself ahead of time

Personal Information

Last Name*:

First Name*:

Middle Name:

Email:

   Address*:

City*:
State*:
   Zip Code:
Phone*:

Vital Statistics

Marital Status:

Social Security#:

Date of Birth:

Place Of Birth:

Spouse's Name:

   Spouse's Maiden Name:

Father's Name:

Mother's Name:

Mother's Maiden Name:

Work / Education

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

Funeral Service Info

Place Of Service:

Funeral Home:

Address:

Phone:

Place of Visitation:

   Religious Denomination:

Place Of Worship:

Lodge / Union / Other:

Person in Charge of Final Arrangements:

Special Instructions

Flower Preference:

Music:

Casket Bearers (6):






   Jewelry:

Glasses:

Clothing:

Other:

Other Instructions

Please list any other instructions you may have:

Memorials / Donations

Please list any Memorials or Donations to Charity that you would like:

Options

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

Customized Funerals . Pre-Arrangement Counseling . Burial & Complete Cremation Services