Mayfield Kiser Funeral Home

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Preplanning Form

Personal Information

1. * First Name
2. * Last Name
3. City
4. State
5. * Email Address
6. Phone

Is this preplan for you?

1. Yes
2. No

Preferred service type

1. Burial services
2. Cremation
3. Personalized memorial services
4. Other

Reason for your interest

1. Just exploring
2. Evaluating options
3. I would like to preplan
4. I would like to transfer my preneed

Preferred funding option

1. I would like to prefund
2. I would prefer an unfunded plan

Preferred next steps

1. Please email me
2. Please call
3. I would like to set an appointment

Background

1. Preplanning is a new concept
2. I have explored preplanning previously
3. I have an existing plan

Comments

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