Rodman Funeral Service - Pre-Arrangement Contact Form

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One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral ceremony a personal tribute and assures your family that the service reflects your true wishes.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion when emotional stress make decisions difficult.

Because we realize individual wishes and situations are personal, we want to assure you of our high respect for complete confidentiality. We welcome the opportunity to meet personally with you and your family to discuss our services and your options more fully…or simply to answer questions. Or, you may prefer to file the necessary vital statistics and preferred funeral information with us on-line by filling in the following information:

Personal Information
Name (First MI Last):
Marital Status:
Social Security#:
Date of Birth:
Place Of Birth:
Address 1:
Address 2:
City:
County:
State:
Zip:
Phone:
E-mail:
Spouse's Name:
Spouse's Maiden Name:
Father's Name:
Mother's Name (with Maiden Name):

Work/Education History
Education:
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:
Person in Charge:
Address:
Phone:
Insurance Information:

Funeral Service Request
Place Of Service:
Funeral Home:
Address 1:
Address 2:
Phone:
Place of Visitation:
Religious Denomination:
Lodge/Union:

Bearer Instructions
Casket Bearers (6): 1.
2.
3.
4.
5.
6.

Disposition Request
I Prefer:
Cemetery:
Address:
Phone:
Section:
Lot #:
I have made a last will and testament:	Yes No
Location:

Other Instructions


Memorials/Donations To Charity


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

Rodman Funeral Service
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5464 North High Street Columbus, Ohio 43214 (614) 840-0911