Orender Family Home
On Line Pre-Arrangement Form
Full Legal Name:
Firstname or Nickname:
Marital Status:   Social Security #:
Date of Birth: Place Of Birth:
Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Father's Name: Mother's Name:
Mother's Maiden Name:
Year Moved here: From:
No. Children: Grandchildren: GreatGrChildren:
Surviving Relatives: Name: Relationship: City/State:
 
 
 
 
 
 
 
Additional Survivors:
Work/Education History
Education (0-12): College 1-5+:
High School:
College:
Degrees:
Occupation:
Business/Industry: Company:
Position/Title:
Date Retired: How Long:
Previously:
Military Record
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Copy of Discharge Papers:    Yes    No
Name Of Wars:
 
Family Member in Charge of Arrangements:
Address:
Phone:
Memberships:

1. City/State:

2. City/State:

3. City/State:

Additional Memberships / Special Interests / Accomplishments:

Insurance Information:
Funeral Service Request
Place Of Service:
Funeral Home:
Address: Phone:
Place Of Worship:
Name of Minister:
Special Instructions
Flower Preference:
Music
Casket Bearers (6):
Jewelery:
Glasses:
Clothing:
Other:
Disposition Request
I Prefer:
Cemetery:
Address: Phone:
Section:
I have made a last will and testament:    Yes    No
Other Notes / Instructions
Memorials/Donations To Charities
(Please provide contact information for each.)