FUNERAL REQUEST

Please complete

Requested Funeral Date and Time:

Date and time

:

Information about the Deceased:

*First and middle names

*Last name

*Birth date:

*Date of death:

Contact Information:

*First and last name:

*Relation to deceased (spouse, son...):

*Email

*Phone

*Country/Region

*Address

*City

*Zip / Postal code

*Are you using a funeral home?

Yes

No

If yes, name and town:

*Location of the funeral:

4 Church Street

Webster, MA 01570

508-943-0061

Office Hours:

Tuesday through Friday

9am to 1pm

Email

Subject

Your message

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