FULL NAME OF DECEASED:

ADDRESS:

CITY/PROVINCE:

FULL NAME OF PERSON REQUESTING:

ADDRESS:

CITY/PROVINCE:

PHONE: HOME WORK CELL (555-5555)

EMAIL ADDRESS:

MEMBERSHIP AT EPUBC: Was the deceased a member of this church?

                                    Are you a member of the Church?

IF NOT, MEMBER OF WHAT CHURCH:

DATE AND TIME OF FUNERAL REQUESTED: DATE TIME  (Example 2:00pm)

DATE AND TIME OF WAKE REQUESTED: DATE   TIME  (Example 2:00pm)

RESPONSIBLE FUNERAL HOME:

REPASS FOLLOWING FUNERAL?

BURIAL AT EAST PRESTON UNITED BAPTIST CHURCH CEMETERY?

COST: THERE IS A COST FOR THE USE OF THE CHURCH AND FOR THOSE FROM THE CHURCH WHO PARTICIPATE IN THE FUNERAL. A FULL LIST OF COSTS WILL BE PROVIDED TO YOU. THESE COSTS COULD INCLUDE THE COST OF USING THE CHURCH, UTILITIES USED, PASTOR OFFICIATING THE SERVICE, MUSICIAN AND/OR CHOIR, OTHER COSTS, ETC.

*COSTS MUST BE PAID IN FULL BEFORE FUNERAL.*

OTHER SERVICE REQUEST /DETAILS:

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