Girrbach Funeral Home has various pre-arrangement options. For specific details on those options, please contact the funeral home.
More and more people are choosing to preplan their funeral arrangements. Key benefits for preplanning:

•    Relieves stress on loved ones
•    Concise decisions regarding
•    Individual wishes can be made known to family members
•    Preliminary steps can be taken to qualify for Medicaid services

Pre-payment of funeral expenses is encouraged, but not a requirement. The key benefit for pre-payment of funeral arrangements:

•    Guarantees the funeral cost at today's current prices

Personal Information	* = Required Information
Last Name:*
First Name:*
Middle Name:
E-Mail:*
Address:*
City:*
County:
State:*
Zip Code:*
Phone #:*	ex: xxx-xxx-xxxx
Vital Statistics
Date of Birth:	JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember   12345678910111213141516171819202122232425262728293031
Place of Birth:	City, ST
Marital Status:	...Choose One... Never Married Married Divorced Widow Widower
Social Security #:	ex: xxx-xx-xxxx
Spouse's Name:
Spouse's Maiden Name:
Date of Marriage:	JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember   12345678910111213141516171819202122232425262728293031
Place of Marriage:	City, ST
Father's Name:
Mother's Name:
Mother's Maiden Name:
Work/Education
Education (K - 12):	K 123456789101112
College (0-5+):	012345
Occupation:
Business:
Company:
Military Record
Branch of Service:	...Choose One... Air Force Army Coast Guard Marines Navy
Serial #:
Date Enlisted:	JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember   12345678910111213141516171819202122232425262728293031
Date Discharged:	JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember   12345678910111213141516171819202122232425262728293031
Rank at Discharge:
Discharge on file at:
Copy of Discharge Papers:	Yes   No
Name of Wars:
Funeral Service Info
Place of Service:	...Choose One... Girrbach Funeral Home Church Cemetery Other
Name:
Address:
City, ST Zip:	,
Phone #:	ex: xxx-xxx-xxxx
Place of Visitation:
Religious Denomination:
Place of Worship:
Lodge/Union:
Final Arrangements By:
Phone #:	ex: xxx-xxx-xxxx
Special Instructions
Flower Preference:
Music:
Casket Bearers:
Jewelry:
Glasses:
Clothing:
Other:
Disposition Request
Final Disposition:	...Choose One... Earth Burial Entombment Cremation
Cemetery:
Address:
City, ST Zip:	,
Phone #:	ex: xxx-xxx-xxxx
Section:
Location:
Other Instructions:
I have made a last will and testament:	Yes   No
Memorials & Donations
Please list any Memorials or Donations to Charity that you would like:
Obituary Information
Employment Information: Please include dates or number or years worked and employer names.
Preceeded in Death by:
Survived by: Please include the names and cities survivors reside in.
Organizations:
Hobbies:
Number of Death Certificates Needed:	1234567891011121314151617181920
Options
Please Select One:*	Send information about my pre-arrangement Contact me to set an appointment Please keep my information on file