Victory Funeral Services - Providing heartfelt services with dignity

Funeral Pre-Planning Form
(Page 2)

Type of service you desire:
Traditional Funeral with Burial
Memorial Service with Burial
Funeral Service with Entombment
Graveside Service
Funeral Service with Cremation
Direct Cremation
No Formal Service
Viewing Preferences:
Family Only
During visitation only
Prior to funeral service only
Prior to funeral service and at end of service
End of funeral service only
At graveside service
No viewing
Name of Desired Cemetery (if owned, give description if available, e.g., Memorial Gardens, Kilgore, TX, Section 3, Block D, Lot 28):
Plot in Whose Name:
Location of Deed (e.g., safe deposit box at):
Cemetery Contact Person:
Cremation - Disposition of Ashes:
Funeral service to be held at:
Funeral Home
Name of facility:
Clothing Instructions:
Clergy - State name and phone number
Scripture: Old Testament:
Scripture: New Testament:
Soloist(s) (separate by commas):
Acknowledgement read by:
Master or Mistress of Ceremony:
Special reading of poem, story, etc.
Remarks from audience?
Visitation/Wake Location:
If veteran;
Casket Spray on casket
U. S. flag draped over casket
Fraternal Affiliations:
Heroines of Jericho
Order of the Eastern Star
Grand Court Order of Calanthe
Greek Organizations:
Delta Sigma Theta Sorority, Inc.
Alpha Kappa Alpha Sorority, Inc.
Zeta Phi Beta Sorority, Inc.
Sigma Gamma Rho Sorority, Inc.
Alpha Phi Alpha Fraternity, Inc.
Kappa Alpha Psi Fraternity, Inc.
Omega Psi Phi Fraternity, Inc.
Phi Beta Sigma Fraternity, Inc.
Iota Phi Theta Fraternity, Inc.
Comments and/or Location of Fraternal or other Organizational Jewelry/Regalia:
Schools Attended and Year Attended:
Church Membership or Affiliation:
Social or Union Membership
Political Position Held:
Boards Served On:
Special Recognitions (i.e., athletic, political, religious, etc):
Children Names:
Aunts and Uncles:
Number or names of grandchildren:
Pre-deceased by:
Non-family members to be treated as family:
Names of songs to be rendered:
People to Notify - (name and phone number):
Honorary Pallbearers
Flower bearers
Special Instructions/Comments:
NOTE: Any photos to be used on funeral programs or DVD presentation that you would like to have maintained in our files can be scanned and emailed to , snail mailed or delivered to our offices.

Victory Funeral Services, 1004 Martin Luther King Drive, Kilgore, TX 75662 - 903-988-1122 phone  903-234-0511 fax -- dparline@sbcglobal.