Riverside Memorial Chapel, Leaders in Funeral Pre-Planning

Pre-Plan Online

There are numerous benefits to pre-planning a funeral, some of which include:

  • Provides peace of mind
  • Relieves your loved ones of unnecessary concern
  • Reflects your expressed wishes
  • Alleviates financial burden on your family

Please take a few minutes to fill out the Online Pre-planning form below. Once the information is submitted, our representative will review and file it and will be in touch with you to further discuss the details of your arrangements.
NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

 Information About the Person Completing this Form:
* First Name:
* Last Name:
Middle Name:
* E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Person for Whom I Am Pre-planning:

 Vital Information About the Person for Whom Pre-planning Is Being Done:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security #:
Date of Birth: (ex. 1999)
Place of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage: (ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

 Work and Education:
Education:
Usual Occupation (most of life):
Kind of Business:
Company:

 Military Records:
Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers: Yes     No
Name(s) of War(s)/Conflict(s) Toured:

 Funeral Service Information:
Place of Service:
Name of Funeral Home:
Address:
Phone:
I Prefer the Funeral Service To Be:
Religious Denomination:
Place of Worship:
Lodge / Union:

  Person(s) To Finalize Arrangements At Time of Death:
Check here and skip this section if the person filling out
this online form is also the person making the final arrangements.
 
Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

  Disposition Options:
I Prefer:
Cemetery:
Address:
Phone:
Section:
I Have Made A Last Will And Testament: Yes    No

  Other Information & Instructions:
Please list any other instruction or information you would like us to have:

 Memorials & Charities:
Please list any memorials or donations to charity that you would like to declare:

 Options:
Please select one of the options below:
Send Information About Pre-planning
Contact Me To Set An Appointment
Please Keep My Information On File



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Riverside Memorial Chapel.
For generations a symbol of Jewish tradition and uncompromising quality.