Bishop & Johnson Funeral Home, Inc.285 Main St, Hornell NY (607) 324-2700Avoca Funeral Home 22 N. Main St, Avoca NY (607) 566-2300

Online Pre-planning Information Form

Personal Information
First Name:
Middle Name:
Last Name:
E-mail:
Address:
City:
County:
State:
Zip Code:
Phone:
 
Vital Statistics
Marital Status:
Social Security##:
Date of Birth:
Place Of Birth:
Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Father's Name:
Mother's Name:
Mother's Maiden Name:
 
Work/Education
Education (0-12):
College 1-5+:
Occupation:
Business:
Company:
 
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:
 
Funeral Service Info
Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
 
Special-Instructions
Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:
 
Disposition Request
I Prefer:
Cemetery:
Address:
Phone:
Section:
Location:
I have made a last will and testament:     Yes     No
 
Other Instructions
Please list any other instructions you may have:

 
Memorials / Donations
Please list any Memorials or Donations to Charity that you would like:

 
Options
Please select one of the options below:
Send information about pre-arrangement
Contact me to set an appointment
Please keep my information on file
 
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Your funeral and cremation service experts and prearrangement specialists

® Bishop & Johnson Funeral, Inc.
285 Main St. Hornell NY 14843
(607) 324-2700
Our webmaster: Mystic Media