Funeral Service Request Form – REHOBOTH FULL GOSPEL MINISTRY

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Funeral Service Request Form

Church Name *

Requested Service(s) *

Deceased Information

Full Name of the Deceased *

Date of Birth *

Date of Passing *

Place of Birth *

Place of Death *

Age at time of passing *

GenderMaleFemale

Occupation/Profession

Marital Status

Next of Kin/Family Information

Full Name of Next of Kin/Primary Contact *

Relationship to the Deceased

Phone Number *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country *

Family Contact(s) *

Funeral Service Details

Preferred Date of Funeral *

Preferred Time for Service *

Hours

Minutes

Type of Service *Traditional BurialCremationMemorial ServiceGraveside Service

Preferred LocationChurchFuneral HomeCemeteryOther

Do you have a specific officiant/pastor in mind?YesNo

Name of the Officiant *

Do you have specific service requests?

Would you like music played during the service? *YesNo

If yes, specify music preferences *

Will there be pallbearers? *YesNo

If yes, provide pallbearer names

Cemetery/Burial Information

Cemetery Name (if applicable)

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Grave Plot Number

Is the grave already purchased? *YesNo

Do you need assistance purchasing a grave plot? *YesNo

Will there be a graveside service? *YesNo

Special Instructions or Personal Touches

Are there any special requests for the service?

Do you have any specific themes or decorations in mind?

Deposit Amount Paid *YesNo

Balance Due (if applicable)

USD

Do you need financial assistance for funeral expenses?YesNo

Emergency Contact Information

Full Name *

Relationship to the Deceased *

Phone Number *

Email Address *

Consent and Agreement

Do you agree to the funeral home or church’s terms and conditions for services? *YesNo

Signature of Next of Kin/Primary Contact(Use your Full Names) *

Date of Signature *

Please do not fill in this field.

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