Submit Vital Information

Vitals-Preneed

WHO IS THIS pre-arrangement FOR?

First Name

Middle Name

Last Name

Suffix

Gender

Maiden Name

Date of Birth

Birthplace

Social Security

CONTACT INFORMATION

Email Address

Cell Phone

Home Phone

Street

City

State/Province

ZIP/Postcode

County

Is Residence Inside City Limits?

MARITAL STATUS

Marital Status

Spouse's Full Name

Spouse's Maiden Name

OPTIONAL INFO

Is the person a military veteran?

Race

Highest Education

Main Occupation

PARENTS' names

Father's Full Name

Mother's Full Name

Mother's Maiden Name

IF You Are Arranging For Someone Else, Your Information:

Informant Full Name

Relationship to the Person Above

Email Address

Cell Phone

Home Phone

Street

City

State/Province

ZIP/Postcode

CREMATION DECISIONS

Is there a pacemaker present?

After the cremation

URN SELECTION

After the cremation, in what type of container would you like your loved one's cremated remains returned? (choose one)

SERVICE / CEREMONY

Will there be a ceremony before or after the cremation?

FINAL Resting Place

Final Resting Place:

Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.

A year of daily grief support

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Our Location

Integrity Funeral Care
| 3915 Dacoma St Ste E
| Houston, TX 77092
| Tel: 713-344-0764
| Fax: 713-583-7461

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What Do I Do Next?

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Stationery

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F.A.Q.

Veterans

Veterans Overview
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Contact Us

Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.