Pre-Arrangement Form

On-line Pre-Arrangement Form :

Thanks for taking the time to fill out our At Need Form. By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help Cook Family Funeral Home complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes. Relaying required statistical information can be time consuming. Our desire is to help expedite the final arrangement conference at the funeral home and make the process a little more comfortable.

Please complete (as much as possible) the information on the form and select Submit Information at the end to send the information to us. You may also print out the form and bring it with you to the arrangement conference or fax.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. Click Here for further instructions and the download link, if interested.

If you have any questions whatsoever, please contact Cook Family Funeral Home at: (206) 842-2642 or (360) 779-7872

Printable At Need Form...Click Here Printable Biographical Information Form.....Click Here

Information about person completing the form:
I am Planning for:
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Vital Information about the person you are planning for:
Last Name:
First Name:
Middle Name:
Street Address:
City:
County:
State:
Zip Code:
Length of time at residence:
Sex:
Marital Status:

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:
Name Of Wars:

Funeral Service Information:
Place Of Service:
Name of Funeral Home:
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 (6):
Jewelry:
Glasses:
Clothing:
Other:

Disposition Options:
I Prefer:
Cemetery:
Address:
Phone:
Section:
I have made a last will and testament:

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

Please list any Memorials or Donations to Charity that you would like:

Please select one of the options below:

Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file