Chopyak-Scheider Funeral Home, Inc.

Great!

Your application have been submitted.
Thank you for taking the time to complete this form. A member of our staff will review your information and contact you to further discuss the details of your arrangements.

Step 1 - Information about whom this plan is for

Relationship to Applicant

First Name:

Midddle Name:

Last Name:

Gender at Birth

Male

Female

Step 2 - Your Information

First Name:

Midddle Name:

Last Name:

Phone:

E-mail:

Step 3 - Biographical information

Birth Date:

Birth Place:

Step 4 - Family information

Marital Status

Married

Single

Widowed

Spouse Name:

Marriage Date:

If deceased, date of death:

Father's Name:

Address - If Living:

City:

State:

Zip/Postal Code:

Mother's Name:

Address - If Living:

City:

State:

Zip/Postal Code:

Siblings (Living):

Siblings (Deceased):

Children (Living):

Children (Deceased):

Grandchildren (Living):

Grandchildren (Deceased):

Great Grandchildren (Living):

Great Grandchildren (Deceased):

Step 5 - Education & Work

Highest Level of Education:

School Name:

School Location:

Occupation:

Company:

Years at Company:

Step 6 - Military Service

Military Service

Yes

Branch of Service:

Years Served:

Step 7 - Visitation Options

Visitation Options:

Visitation at funeral home.

Visitation at:

I do not wish to have visitation hours.

Step 8 - Funeral Service Options

Funeral Service Options:

Funeral service at funeral home.

Funeral service at:

I do not wish to have a funeral service.

Step 9 - Reception Options

Reception Options:

Reception at:

I do not wish to have a reception.

Step 10 - Would you prefer burial or cremation?

Burial

Cremation

Step 11 - Final Disposition

Ground Interment (Burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Cremains returned to family

Step 12 - Would you prefer to include a graveside/committal service?

Yes

Last Step - Service Requests

Please list any musical selections you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any interests or hobbies you would like to include into your services.

Please list any special themes you would like to include into your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Pre-Plan Online Application