Immediate Need

If a Death Has Just Occurred

First, let us express our deepest sympathy for your loss. Know that we are here for you and your family during this difficult time.

If you've not done so, please call us at (570) 282-1219 day or night. We will make arrangements to bring your loved one into our care and will set a time to meet with you in your home to begin the funeral arrangements.

Immediate Need Form

Free Text

Personal Information of Deceased

Last Name*

Middle Name

First Name*

Date of Birth*

Date of Death*

Social Security Number*

Free Text

Preparation Information

Has a Doctor / Coroner Been Notified?

Yes

Free Text

Physician Information

Name of Doctor Signing Death Certificate

Email Address

Business Telephone

Street

City

State/Province

Zip/Postcode

Free Text

Personal Information of Person Legally Responsible for Disposition

Last Name*

Middle Name

First Name*

Relationship to Deceased*

Street*

City*

State/Province*

Zip/postcode

Primary Phone Number*

Secondary Phone Number

Best Time to Reach Via Phone*

Do You Have a Prearrangement on File with Us?

If Yes, Under What Name?

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Immediate Need

If a Death Has Just Occurred

Immediate Need Form

Main Office

Branch Office

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Immediate Need

If a Death Has Just Occurred

Immediate Need Form

Main Office

Branch Office