On-line Pre-planning Form

There are numerous benefits to pre-arranging a funeral, some of which include:

  • Provides peace of mind
  • Relieves your loved ones of unnecessary concern
  • Reflects your expressed wishes
  • Alleviates financial burden on your family

Please take a few minutes to fill out the On-line Pre-planning Form, below. Once submitted, a Bellows-Falso Funeral Chapel representative will then review your information and will be in touch with you to further discuss the details of your arrangements.

If you'd rather fill out a print version of the form click here.


NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Information About The Person Completing This Form:

* First Name:
* Last Name:
Middle Name:
* E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Person for Whom I Am Making Pre-arrangements:

Vital Information About The Person For Whom Pre-arrangement Is Being Done:

Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security #:
Date of Birth: (ex. 1999)
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage: (ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:

Education:
Usual Occupation:
(most of life)
Kind of Business:
Company (Optional):

Military Records:

Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers: YES    NO
Name(s) of War(s)/Conflict(s) Toured:

Funeral Service Information:

Place Of Service:
Address:
Phone:
Place of Visitation:
I Prefer The Funeral Service To Be:
Viewing For Family:
Viewing For Friends:
Religious Denomination:
Place Of Worship:
Lodge / Union:

Person(s) To Finalize Arrangements At Time Of Death:

Check here and skip this section if is information is the same as person filling out this form
 
Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Special Instructions:

Flower Preference:
Music
Casket Bearers (x6):
Jewelry:
Glasses:
Clothing:
Other:

Disposition Options:

I Prefer:
Cemetery:
Address:
Phone:
Section:
I Have Made A Last Will And Testament: YES   NO

Other Information & Special Instructions:

Please list any other instruction or information you would like us to have:


Memorials & Charities:

Please list any memorials or donations to charity that you would like to declare:


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



Pre-planning Form - Print Version

You can also download this form and mail it to us or bring with you when you visit, please click here.

Get Adobe Acrobat ReaderNOTE: It is recommended to right-click the link above and choose to save the PDF to your local computer where it can then be opened with Adobe's Acrobat Reader. If you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the download page.

Mail or bring completed form to this address:
160 River Road
Lincoln, Rhode Island 02865
Please call with any questions: (401) 723-9792

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