Immediate Need Form

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We understand that making the many decisions which come at a time of loss can be difficult. We offer our support by providing you with two options as you consider making immediate arrangements.

In Person

Please call us at (910) 653-2104 to make arrangements in person with a caring, professional funeral director. Call us any time - we are available 24 x 7.

Online

Arrangements can be made in the comfort of your own home by filling the form below. Fill in as much as you are comfortable with and we'd be pleased to meet with you to discuss further. See the form below for details.

Arrangement Information

Personal Information of Deceased

Last Name

First Name

Middle Name

Sex

Father's Name : First

Middle

Last

Mother's Name: First

Middle

Last

Mother's Maiden Name

Race

African-AmericanCaucasianNative AmericanHispanicAsian

Country of Origin

Date of Birth

Social Security Number

City of Birth

State or Province

OR Country (If Not USA)

Date of Death

Time of Death

City of Death

State of Death

Education

Primary

College

Usual Occupation(Most of Life)

Type of Business

Company(optional)

Marital Status

Surviving Spouse

If wife, enter maiden name

Surviving Spouse Address

Street

City

State/Province

ZIP/Postcode

Mother's full name

Father's full name

Preparation Information

Has a Doctor / Coroner Been Notified?

YesNo

If deceased passed at home

Has the Body Been Released for Removal?

YesNo

Do You Permit Us to Embalm the Body?

YesNo

Do You Permit Us to Cremate the Body?

YesNo

If Yes, Who Has Granted Permission?

Physician Information

Name of Doctor Signing Death Certificate

Street

City

State/Province

ZIP/Postcode

Business Telephone

Email Address

Type of Disposition

Disposition will be

If cremation, disposition of ashes

Preparation and Viewing

Viewing/embalming preference

I authorize Inman Ward Funeral Home to embalm

Veteran Information

Was the decendent ever in the US Armed Forces?

YesNo

If no, continue to the next section.

Branch of Service

Date Enlisted

Date Discharged

Service/Serial Number

Honorable Discharge

YesNo

Copy of Discharge Papers is available

YesNo

Informant Information

Personal Information of Person Legally Responsible for Disposition

Last Name

First Name

Middle Name

Relationship to Deceased

Street

City

State/Province

ZIP/Postcode

Primary Phone Number

Best Time to ReachVia phone

Secondary Phone Number

Do You Have a Prearrangement on File with Us?

YesNo

If Yes, Under What Name?

Funeral/Memorial Service Information

Preferred place of service

Religious denomination

Is there pre-need funeral insurance on decedent?

YesNo

If yes, specify typeIf yes, specify type

Memorials & donation preferencesPlease list memorials or charitable donations that you'd like listed in the obituary

Special Instructions Optionally use the area above to provide additional information or instructions to us.

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