Pre-Arrangements Form 

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Use this form to provide us with as much or as little detail as you wish.  At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Pre-Arrangement Details

Personal Information

Please use the area above to enter the names of siblings, children and grandchildren.

Work/Education History

Military Record

Funeral Service Request

Disposition Request

(if applicable)
(if applicable)
(if applicable)

Summary Details

Send Us a Message

Contact Us

Call Us
1-330-674-4811 

location_on Address
8612 Ohio 39 P.O. Box 108
Millersburg, OH 44654  

access_time Hours
Mon - Fri 9:00 am to 4:30 pm

You are welcome to call us any time of the day, any day of the week, for immediate assistance. Or, visit our funeral home in person at your convenience.

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