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On-line Pre-arrangement Form

There are numerous benefits to Pre-arranging a funeral, some of which include:

  • Provides peace of mind
  • Relieves your loved ones of unnecessary concern
  • Reflects your expressed wishes
  • Alleviates financial burden on your family

Please take a few minutes to fill out the Online Pre-arrangement form below. Once the information is submitted, a Irwin Chapel representative will review and file it and will be in touch with you to further discuss the details of your arrangements.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link, if interested.
NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Information about the Person Completing this Form:
* First Name:
* Last Name:
Middle Name:
* E-mail:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Person for Whom I Am Pre-arranging:

Vital Information about the Person for Whom Pre-arranging Is Being Done:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security #:
Date of Birth: (ex. 1999)
Place of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage: (ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:
Education:
Usual Occupation (most of life):
Kind of Business:
Company:

Military Records:
Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers: Yes     No
Name(s) of War(s)/Conflict(s) Toured:


Funeral Service Information:
Place of Service:
Name of Funeral Home:
Address:
Phone:
Place of Visitation:
I Prefer the Funeral Service To Be:
Viewing for Family: Yes    No
Viewing for Friends: Yes    No
Religious Denomination:
Place of Worship:
Lodge / Union:

Person(s) to Finalize Arrangements at Time of Death:
Check here and skip this section if the person filling out
this online form is also the person making the final arrangements.
 
Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Special Instructions:
Flower Preference:
Music
Casket Bearers (x6):
Jewelry:
Glasses:
Clothing:
Other:

Disposition Options:
I Prefer:
Cemetery:
Address:
Phone:
Section:
I Have Made A Last Will And Testament: Yes    No

Other Information & Instructions:
Please list any other instruction or information you would like us to have:

Memorials & Charities:
Please list any memorials or donations to charity that you would like to declare:

Options:
Please select one of the options below:
Send Information About Pre-arrangement
Contact Me To Set An Appointment
Please Keep My Information On File



Pre-arrangement Form - Printer-friendly Version:

You can download the printer-friendly version of the Pre-arrangement form to your local computer from the link below. Once downloaded, open the PDF *, and enter your information on the form, then print it out on your printer. You may then either mail or fax it to us at the address or fax number below, or bring it with you when you visit.

»   CLICK HERE to download the form - choose to, 'Save to Disk,' in the dialog box that appears (download times will vary depending upon connection.)
Get Adobe Acrobat Reader* NOTE: Adobe Acrobat Reader software is required to view this file - if you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the download page.

Mail completed forms to the following address:

Irwin Chapel
591 Glen Crossing Road
Glen Carbon, Illinois 62034

Please call with any questions: 618-288-9500


591 Glen Crossing Road | Glen Carbon, IL 62034 | Phone: 618-288-9500
3960 Maryville Road | Granite City, IL 62040 | Phone: 618-931-8000
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Dolores Meehan
June 22nd, 2013
Frieda Andrews
June 17th, 2013
Charlotte Minks
June 17th, 2013
Ronald Crump
June 15th, 2013
Elizabeth Gray
June 12th, 2013
Clara Parker
June 12th, 2013
Marvin Boyer
June 10th, 2013
Theresa Knight
June 10th, 2013
Marlyse Reed
June 8th, 2013
Edward Greer
June 7th, 2013
Dennis Laird
No Service
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