Pre-Need

Pre-Planning your funeral arrangements will express your wishes, and give you and your family the security and peace of mind knowing that all the arrangements have been planned and paid for. If you are ready to begin the pre-planning process, call us at (605)376-7047, email us at contact@harrisburgchapel.com, or fill in the form below.

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1. Personal Information

Name*

Phone Number*

Email Address*

Street Address

City

State

Zip

Birth Date

Birth Place

Marital Status

Spouse's Name

Spouse's Maiden Name

Spouse's Phone Number

2. Work & Education

Education (K-12)

College

Occupation

Company

3. Military Record

Branch of Service

Serial Number

Date Enlisted

Date Discharged

Rank

Discharge on file at

Copy of discharge papers? Yes No

Wars served in

4. Funeral Arrangements

Place of Visitation

Place of Funeral

Religious Denomination

Place of Worship

5. Family Information

Parents

Children

Siblings

Grandchildren

Other Relatives

6. Special Instructions

Lodges and Organizations

Jewelry

Glasses

Clothing Preference

7. Disposition Request

I prefer Earth Burial Mausoleum Cremation

Cemetery

Section

Last will and testament exists?

Will Location

8. Other Instructions

Special Requests

Memorials or donations to charity

Options for further contact Send me more information about pre-arrangement Contact me to set an appointment

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