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For Immediate Need Call: 570-675-3255

For Immediate Need Call: 570-675-3255

ABOUT
OBITUARIES
SERVICES
PLAN AHEAD

GRIEF SUPPORT
RESOURCES
Blog
Blog

Online Preplanning Form

Start Planning Online Today

Online Preplanning Form

Free Text

Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

Address

City

State/Province

ZIP/Postcode

Phone Number

Email Address

Date of Birth

Place of Birth

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Family Information

Father's Name

Father's Place of Birth

Mother's Name

Mother's Place of Birth

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

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Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

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Education History

Highest Level of Education

Grade School

High School

Degree

Masters Degree

Doctorate

School Name(s)

School Location(s)

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Work History

Occupation

Company Name

Years At Company

Business Field

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Military Record

Did you serve in the military?

Yes

No

Branch of Service

Serial Number

Date Entered Service

Rank at Discharge

Date Discharged

Discharge on file at

Do you have a copy of your discharge papers?

Yes

No

Wars fought in

Person in Charge

Person in Charge Address

Person in Charge Telephone

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Funeral Service Request

Place of Service

Funeral Home

Church

Cemetery

Place of Service Telephone

Place of Visitation

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

Person in charge of final arrangements

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Disposition Request

I Prefer

Earth Burial

Mausoleum

Cremation

Other

Cemetery

Lot Number

Section/Letter

Grave Number

Cemetery Address

Cemetery Telephone

I have made a last will and testament

Yes

No

Location of Will

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Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me a link to pre-arrange online

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Please keep my information on file

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CONTACT US

Phone:

Edward Horn, 570-760-2090

Janice Horn, 570-817-2303

Email:

disquefh@hotmail.com

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CONTACT US

Phone:

Edward Horn, 570-760-2090

Janice Horn, 570-817-2303

Email:

disquefh@hotmail.com

Copyright © Richard H. Disque Funeral Home, Inc. All Rights Reserved

Copyright © Richard H. Disque Funeral Home, Inc. All Rights Reserved

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