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Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information

Please contact me to schedule an appointment

Please place my information on file


 

 

 

 

 

Our Services

We understand that it is not always possible to pay respects in person, & hope that this small token will help. You can search for your loved one using the form below.

Enter your email below to have our funeral service notifications delivered to you

Providing your email address will allow us to notify you of recent obituaries.

Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Obituaries & Tributes

It is not always possible to pay respects in person, so we hope that this small token will help.

Prearrangement

Dying is one of the few events in life that's certain to occur, yet one we rarely plan for. Should we spend more time preparing for a two week vacation than we do our last days on Earth?

Daily Grief Support by Email

Grieving doesn't always end with the funeral: subscribe to our free daily grief support email program, designed to help you a little bit every day, by filling out the form below.

Weekly Email Tips to Support a Grieving Friend

It's hard to know what to say when someone experiences loss. Our free weekly newsletter provides insights, quotes and messages on how to help during the first year.

Proudly Serving the Communities of Indiana, Homer City, Parkwood, Brush Valley, Ernest, Kent, Lucernemines, Penn Run, McIntyre, Aultman, Clarksburg, Shelocta, Iselin, Clune, Coal Run, Jacksonville, Islan, Chevy Chase, Red Barn, Chambersville, Creekside, Waterman, Clymer, Marion Center, Dixonville, Home, Penn Run, Commodore, Cookport, Heilwood, Starford, Alverda, Pine Flats, Barr Slope, Kenwood, Diamondville, Prosperity Hill, Buck Run, Marchand, Nicktown, Strongstown, and Mentcle
724-349-2000 Rairigh - Bence Funeral Home, Inc. of Indiana
965 Philadelphia St
Indiana, PA 15701-3935
Email: rairighfd@gmail.com
724-254-4342 Rairigh - Bence Funeral Home, Inc. of Clymer
655 Franklin Street
Clymer, PA 15728
Email: rairighfd@gmail.com
724-349-2000 Rairigh - Bence Funeral Home, Inc. of Indiana
965 Philadelphia St
Indiana, PA 15701-3935
Email: rairighfd@gmail.com
724-349-2000 Rairigh - Bence Funeral Home, Inc. of Indiana
965 Philadelphia St
Indiana, PA 15701-3935
Email: rairighfd@gmail.com
724-349-2000 Rairigh - Bence Funeral Home, Inc. of Indiana
965 Philadelphia St
Indiana, PA 15701-3935
Email: rairighfd@gmail.com