Preplan Online

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HOME
CONTACT US
MIDWEST MEMORIALS

MIDWEST PREPLANNING
MEET YOUR TEAM

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

Date of Birth

Place of Birth

Social Security Number

Phone Number

Email Address

Free Text

Family Information

Mother's Name

Father's Name

Mother's Madien Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Free Text

Education History

Highest Level of Education

Free Text

Work History

Industry

Occupation

Did this person serve in the military?

Yes

No

Free Text

Your Wishes

Would you prefer to include a graveside/committal service?

Yes

No

Undecided

Would you prefer burial or cremation?

Burial

Cremation

Undecided

Final Disposition

Ground Interment (casket burial) radio

Cremation (Fire or Water)

Mausoleum Entombment (above ground burial) radio

Columbarium (for cremation urns) radio

Ashes returned to family radio

Terramation

Green Burial

Undecided

Funeral Service Option

Funeral service at Church

Celebration of Life

Funeral service at funeral home radio

Funeral service elsewhere radio

No Visitation radio

Undecided

Free Text

Your Preferences (not required to complete)

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 musical selections you would like to include in your services.

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

Comments, Questions, Or other information you would like to share:

Free Text

Upload Any Requested Documents:

Example: POA, DD-214, Transfer Documents, Other Documents

Example: Military DD-214, POA Documents, Policy Documents, Other Documents)

File Upload 1.

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File Upload 2.

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File Upload 3.

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File Upload 4.

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File Upload 5.

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File Upload 6.

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Email: info@midwestlegacies.com

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