Prearrangement Checklist
PRE-NEED OR AT-NEED CONTACT AND INFORMATION SHEET
Clergy:
Name:
Church:
Address:
Phone:
Attorney:
Name:
Address:
Phone:
Parents Names
Father:
Mother:(maiden name)
Executor of Estate
Name:
Place of original copy of will:
Accountant (Financial Advisor):
Name:
Address:
Phone:
Social Security Administration:
Social Security Number:
Veterans Service Agency:
Branch of service:
Copy of military discharge papers:
Service Dates:
Motor Vehicle Bureau:
State Drivers Licensee Number:
Union Affiliations:
Club Affiliations:
(cancel memberships – ex. Elks)
Banks:
Checking:
Savings:
Certificate of Deposit:
Annuity:
Mortgage:
Safe Deposit Box (es):
Names on box:
Locations of keys:
Bank:
Credit Union:
Name:
Address:
Phone:
Real Estate Broker:
Name:
Address:
Phone:
Insurance Agent:
Medical:
Policy Number:
Life:
Policy Number(s):
Home:
Policy Number:
Automobile:
Policy number:
Pension Plan:
Name:
Address:
Phone:
Medical Professionals*
Doctor:
Address:
Phone:
Doctor:
Address:
Phone:
Dentist:
Address:
Phone:
*cancellation of any previously made appointments |