Plan Online (Riverview)

Your Name*:

Your Contact Phone Number*:

Your Contact Email*:

When do you need our Services?*:

This Plan is for? (select one)*:

Full Legal Name (for whom this plan is for):

AKA or Nick Name(s):

Gender:

Male

Female

Birth Date:

Birthplace:

Military Service/Veteran:

Specify Branch:

Specify Years or Wartime Era:

Upload DD-214:

Hispanic Origin?:

Yes

Race:

Education:

Social Security Number:

Legal Marital Status:

Surviving Spouses’ Name (Maiden for Wife):

Legal Residence (Full Address):

Father’s Name:

Mother’s Maiden Name:

Informant's Full Name (Contact Person):

Informant's Telephone:

Informant's Email Address:

Informant's Mailing Address:

Informant's Relation to Beneficiary :

VISITATION OPTIONS (choose one):

FUNERAL OPTIONS (choose one):

Burial Or Cremation?*:

Graveside/Committal Service?:

DISPOSITION OPTIONS:*:

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?:

Please wait

Pre-Planning Form