Pre-Planning Form

Fayetteville Chapel
180 N Jeff Davis Dr.
Fayetteville, GA 30214
Phone 770-461-7641
Fax 770 460-1003

Peachtree City Chapel
200 Robinson Road
Peachtree City, GA. 30269
Phone 770-487-3959
Fax 770-487-5959

I am planning for::
Information of the person being planned for:
Name:
Address:
City:
State:
Zip Code:
Place of Birth:
Date of Birth:
Sex:
Citizenship:
Marital Status:
Spouse (Maiden Name):
Father's Name:
Mother's Maiden Name:
SSN:
Religous Preference:
Information for how you wish to be contacted
Telephone:
Email Address:
Address:
City:
State:
Zip:
Name of PrePlanner (If planning for someone other than yourself):
Education
High School Name:
College Name:
Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)
Survivors:
Preceded in Death by::
Additional Information:
Work History
Occupation:
Industry:
Company:
Military Service
Service Branch:
Awards or Medals:
Would you prefer military honors at the service:
Funeral Preferences
I prefer my Funeral Service to be
Public:
Private:
Visitation
Public:
Private:
Place of Service:
Other:
I Prefer
Cremation:
Burial:
Entombment:

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