Reichlin-Roberts Funeral Home

327 Cleveland Street, Elyria, Ohio 44035
E-mail: reichlinroberts@yahoo.com              Telephone: 440-365-1271

PRE-PLANNING

Talking about death is often difficult. Pre-planning a funeral can help to alleviate problems that arise with the death of a loved one. It is a thoughtful gift that you can give your family.
We are always available for advice before the need arises. Call Ron Roberts or Mark Reichlin today at 440-365-1271 or fill in the following call back sheet and we will be happy to discuss your options. You can lock in today’s prices by pre-paying or simply place your wishes on file for future use.

 Family
  • Expert pre-planning advice and financing through a licensed funeral director
  • Give yourself peace of mind by knowing that you will have the service that reflects your wishes
  • Reduce the stress and financial burden on your loved ones
  • Protect against increasing funeral costs and pay for tomorrows funeral at today’s cost
 
Full Name: Birthplace:
Date of Birth: Marital Status:
Name of Spouse: Date of Marriage:
Fathers Name: Mothers Maiden Name:
Mothers Name: Occupation:
Business: Education:
FUNERAL SERVICE REQUESTS
Name of Funeral Home: City and State:
Place of Service: Church Denomination:
Lodge or Union: Persons to be in charge of final arrangements:
Relationship: Address:
    Phone:
MILITARY RECORD
Name of War: Serial No.
Date & Place of Induction Date & Place of Discharge
Branch of Service: Rank at Discharge:
SPECIAL INSTRUCTIONS
Flower Preference: Music Preference:
Casket Bearers: Jewelry:
Glasses: Clothing:
Obituary: Others:
PERSONS TO BE NOTIFIED   INSURANCE INFORMATION
 
INTERMENT REQUESTS
I Prefer: Name of Cemetery:
City & State: I Have Reserved Facilities:
I have made a last will & testament: It is located at: