On-Line Pre-Planning Form

On-Line Pre-Planning

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 form below. Once the information is submitted, a Smith-Lund-Mills representative will review and file it and will be in touch with you to further discuss the details of your arrangements.

Pre-planning Form

Information about the Person Completing this Form:

* First Name:

* Last Name:

Middle Name:

* E-mail:

Street Address:

City:

County:

Zip Code:

Phone:

Vital Information about the Person for Whom Pre-arranging Is Being Done:

Last Name:

First Name:

Middle Name:

Social Security #:

Date of Birth:

Place of Birth:

Spouse's Full Name:

Spouse's Maiden Name:

Place of Marriage:

Date of Marriage:

Father's Full Name:

Mother's Name:

Mother's Maiden Name:

Work and Education:

Usual Occupation (most of life):

Kind of Business:

Company:

Military Records:

Serial Number:

Date Enlisted:

Rank At Discharge:

Date Discharged:

Discharge On File At:

Name(s) of War(s)/Conflict(s) Toured:

Funeral Service Information:

Name of Funeral Home:

Address:

Phone

Place of Visitation:

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:

Special Instructions:

Flower Preference:

Music

Casket Bearers (x6):

Jewelry:

Glasses:

Clothing:

Other:

Disposition Options:

Cemetery:

Address:

Phone:

Section:

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:

Get in Touch

Smith Lund Mills Funeral Chapel & Crematorium

123 S 7th St.

Cottage Grove, OR 97424

Phone: (541) 942-0185