Make Arrangements Online

Whether you’re planning ahead or making arrangements for someone who has passed, the form below will help speed up the process. The information you provide will help Phaneuf Funeral Homes & Crematorium complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your wishes.

Please provide as much information as possible and then submit the form. If you’d prefer a print friendly version of this form, click the button below to download and fill out manually. You can bring that paperwork in with you and meet with a funeral specialist who will assist you with the process.

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.

Download Printable Form

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First Name*
Last Name*
Middle Name
Sex
Race
Date of Birth
Month
Day
Year
Place of Birth
City State / Province / Region Country
Location of Death
If other, please indicate address
Name of the Place of Death
Location of Death (other)
Street Address City State ZIP Code
Primary Education
Secondary Education

Name*
First Last
Relationship To Deceased
Email*
Address
Street Address City State ZIP Code
Phone
Preferred Place of Service
Religious Denomination
Is there Immediate Need Funeral Insurance on decedent?
- Yes
- No
If Yes, Specify Insurance Type
i.e., Forethought, Purple Cross, trust, etc.
Please list any other instruction or information you would like us to have
Name
This field is for validation purposes and should be left unchanged.

How much will you spend on your funeral?

How much will you spend on your funeral?

How much will you spend on your funeral?

How much will you spend on your funeral?

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Make Arrangements Online

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