On Line Pre-Plan Form

PREARRANGEMENT FORM

We honor all prearrangements made at other funeral homes.

Many individuals and families today are making the decision to preplan their funerals. By planning ahead, you can be certain that your exact wishes are known and carried out. This also provides an opportunity for you to be involved in personalizing your funeral tribute.
Many people also pre-fund their arrangements in order to relieve their loved ones of the financial stress of a funeral. By using the FORETHOUGHT FUNERAL PLAN, you can pay for your funeral in advance without having to worry about the cost rising before your death.
At Odom Funeral Home, we respect your wishes for complete confidentiality and welcome the opportunity to meet with you personally, at the funeral home or in your home, to discuss your tribute options at a convenient time for you.

Also available for group presentations, call Gregory Odom at 574/842-2082 or e-mail gwo@odomfuneralhome.com to set up an appointment.

You may start planning your tribute today by filling out the pre-arrangement form below.
To maintain your privacy, as this is an unsecured site, we suggest you complete the information and print a copy that you can bring with you to the funeral home.

**Personal Information**
Name First MI Last):
Marital Status:		Social Security #:
Date of Birth:		Place of Birth
Race:		Citizen Of:
Hispanic Origin:
Resident since: (year)		From: (City/State)
Residence Address:		E-mail address:
City:		State:
County:		Zip:
Township:		Phone:
Spouse's Name:		Spouse's Maiden Name:
Spouse's SS#		Place of Marriage:
Date of Marriage:		Father's Name:
Mother's Name:		Mother's Maiden Name:

**Work/Education History**
Education(0-12):		College 1-5+:
Occupation:
Business:		Company:
City:		State:

**Military Record**
Branch of Service:		Serial Number:
Date Enlisted:		Place Enlisted:
Rank At Discharge:		Medals/Honors:
Date Discharged:		Place of Discharge:
Copy of Discharge Papers: Yes No
Name Of Wars:

**Funeral Service Request**
Place Of Service:		Minister:
Church/Other:		Minister's Phone:
Address:	Phone:	Veteran's Graveside Rites:
Place of Visitation:		Rosary/Spiritual Wake:
Religious Denomination:		Organizational Rites:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
Address:
City:	State:
County:	Zip:
Phone:	E-mail:

**Special Instructions**
Flower Preference:
Music
Casket Bearers (6): (leave blank if funeral staff to perform)
Jewelry:
Glasses:
Clothing:
Other:

**Disposition Request**
I Prefer:
Cemetery:
Address:		Phone:
Lot Number:		Space Number:
I have made a last will and testament: Yes No
Location:

**Memberships/Affiliations**

**Hobbies**

**Other Instructions**

**Memorials/Donations To Charity**

**Please select one of the options**
Send information about pre-arrangement Contact me to set an appointment Please keep my information on file

E-mail: info@odomfuneralhome.com

Odom Funeral Home

104 E. Lakeshore Drive

Culver, Indiana 46511
(574) 842-2082

Fax: (574) 842-3898