Online Preplanning Form

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Planning Ahead

Planning in advance is about making your wishes known and we've created this simple online form to assist you. You may fill out as much or as little as you wish, but we do need your basic contact information so we can follow up with you to get any additional information we may need to complete your arrangements.

If you have any questions, or would like assistance with this form, please call 920.324.3071

Online Preplanning Form

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Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

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About You

Email Address

Phone Number

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Family, Work, & Education

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Family Information

Father's Name

Father's Address

Mother's Name

Mother's Address

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

School Name

Highest Level of Education

School Location

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Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

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Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Funeral Service

Reception Options

Reception at funeral home

Reception elsewhere

No Reception

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

No

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Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes 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 specific foods or beverages you would like to make available to your family and guests at the services.

Please list any interests or hobbies 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?

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Werner-Harmsen Funeral Home - Waupun

Phone:

920.324.3071

Fax:

920.324.5711

Address:

201 East Jefferson Street

Waupun, WI 53963-2030

Email:

info@wernerharmsen.com

Services

We are dedicated to provide the funeral service which meets your family’s needs. Our funeral home provides a full range of funeral service options …

Werner-Harmsen Funeral Home - Cambria

Phone:

920.348.5111

Fax:

920.324.5711

Address:

323 Mary Street Cambria,

WI, 53923

Email:

info@wernerharmsen.com

Our Team

Because a death in the family is so personal, we believe that our staff who deal with these families must be especially sensitive and conscientious …

Resources

Area Florists

Area Cemeteries

Legacy Touch Keepsakes

Watertown Memorial Co.

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Online Preplanning Form

Online Preplanning Form

Werner-Harmsen Funeral Home - Waupun

Services﻿

Werner-Harmsen Funeral Home - Cambria

Our Team﻿

Resources

Services

Our Team