Preplan Online

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For Assistance Call: (651) 237-2119

HOME
CONTACT US
MIDWEST MEMORIALS

PREPLANNING
ABOUT US

Planning in advance is about making your wishes known and we've created this simple online form to assist you. You may fill out as much or as little as you wish, but we do need your basic contact information so we can follow up with you to get any additional information we may need to complete your preplanning file.

If you have any questions, or would like assistance with this form, please call (651) 237-2119 or email: info@midwestlegacies.com

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Who is this plan for?

First Name

Middle Name

Last Name

Physical Address

Mailing Adress

Phone Number

Date of Birth

Email Address

Social Security Number

Free Text

Family Information

Father's Name

Mother's Name

Mother's Madien Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

Free Text

Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (deceased)

Grandchildren (alive)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Free Text

Education History

School Name

Highest Level of Education

School Location

Free Text

Work History

Industry

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

Free Text

Your Wishes

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial) radio

Mausoleum Entombment (above ground burial) radio

Columbarium (for cremation urns) radio

Ashes returned to family radio

Visitation Options

Visitation at funeral home radio

Visitation elsewhere: radio

No Visitation radio

Funeral Service Option

Funeral service at funeral home radio

Funeral service elsewhere radio

No Visitation radio

Reception Options

Reception at funeral home radio

Reception elsewhere: radio

No Visitation radio

Would you prefer to include a graveside/committal service?

Yes

No

Free Text

Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Please list any interests or hobbies you would like to include into your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Thank you for contacting us.
We will get back to you as soon as possible.

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PREPLANNING
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ABOUT US

Email: info@midwestlegacies.com

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