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Protocol --Select Protocol-- Traditional Burial with Visitation and Committal Same Day Burial and Committal Chapel Burial with Committal Graveside Burial with Committal Funeral Recipient/Insured Please enter Name SSN Please enter SSN UnCheck here if not Owner Owner Owner Name (If other than Insured) Insured or Owner Address Please enter Address
Funeral Home Services Funeral Home - Select only one please --Select Funeral Home-- Palms West Funeral Home Baldwin Brothers Palm Beach National Chapel Gary Panoch Funeral Home Monarch Funeral Home and Cremations Glick Family Funeral Home Rubin Memorial Chapel Roy Mizell Kurtz Funeral Home Serenity Memorial Chapels Boyd Panciera Family Funeral Care VanOrsdel Funeral Home Poitier Funeral Home Coral Springs Funeral Home DeGusipeFuneral Home Crematory Tillman Funeral Home and Crematory Please select Funeral Home Where will the Memorial be held --Select Location-- Funeral Home Church Chapel Temple None Visitation Length --Select Visitation Length-- 30 Mins 1 Hr 2 Hrs 3 Hrs 4 Hrs 1 Day None National Cemetery --Select Cemetery-- Barrancas National Cemetery Bay Pines National Cemetery Cape Canveral National Cemetery Florida National Cemetery Jacksonville National Cemetery Sarasota National Cemetery South Florida National Cemetery St Augustine National Cemetery Other Family Cars (# of) Rate per Car Forwarding/Receiving Remains Other Services Charge Family ID Family ID Charge Special Discount Amount
Funeral Merchandise Casket or other receptacle Check for casket Promo Manufacturer --Select Manufacturer-- Model --Select Model-- Model Number --Select Model Number-- Exterior Wood Type Steel Gauge 16 18 20 Stainless Copper 32 oz 48 oz Bronze 32 oz 48 oz Exterior Color (optional) Interior Color Lining Crepe Velvet Satin Other Couch Full Couch Half Couch Gaskets Gaskets No Gaskets
Non-Guaranteed Cash Advance Items Obituary Notices Death Certificates (Enter number needed) County --Select County-- Broward County Miami-Dade County Orange County Palm Beach County Seminole County Volusia County Please select County Flowers --Select Flowers-- 100.00 125.00 150.00 200.00 250.00 300.00 Clergy Rabbi Minister Priest Chaplain Richard Stangler Other Other Clergy Charge Music Hairdresser Other (Specify) Our Charge for obtaining the following items Jewish Funeral Items Linen Shroud Muslin Shroud Tahara Shomer Support Staff Motor Escorts Other (Specify)
Select Agent Sharon Stangler Richard Stangler Chris Haarer Sharon Stangler - Asher Richard Stangler - Asher MaryJo Hudson Please select Agent