Plan Ahead | Williams Funeral Home, Inc.

Pre-Planning Survey


 Please print the following information. By completing  this information you authorize a certified pre-planning  agent to contact you.

   Your Name: ______________________

   Phone: _________________________

   Best time to call: ___________________

   Address: ________________________

   City, State & Zip: __________________


We need your help.  We are conducting a survey to determine how members of our community plan for one of the hardest things a family has to face…..the death of a loved one.

The brief questions that follow are designed to assist us in knowing more about what people want and need at this most difficult time.  This will help us improve our service by pinpointing what is most important to you.  Please answer these questions as completely as you can then return the survey in the enclosed postage-paid envelope.

Please complete this survey and return in postage paid envelope.


How old are you?       


1 ___ Under 50                          ___ 66-80              

   ___   51 – 65                               ___ 81 or Older




Are you currently:

2 ___ Employed                           ___ Retired     


Have you ever been responsible for making

Funeral/memorial service arrangements?


3 ___ Yes                                        ___ No



If you have given any thought to the subject,              

Which of the following would you choose for yourself?


4 ___ Burial                                    ___ Cremation


How much might you expect to pay for a funeral or cremation?


5 ___ Under $4,000.00              ___ $6,000.00 - $8,000.00

    ___ $4,000.00 -$6,000.00     ___ Over $8,000.00



In the event of your death, who would be

responsible for making the arrangements?

6 ___    Spouse         ___   Family Members

      ___   Children       ___   Other



Do your loved ones know what you would

want them to choose for you?

7  ___ Yes                  ___ No   


In order to ease the stress on your loved ones, do you feel that it would be considerate to make these final arrangements in advance?

                                                                                            8 ___ Yes                    ___ No


Would it give you peace of mind to know that your

funeral/cremation arrangements have been planned and funded?



9 ___ Yes                     ___ No


May we have one of our pre-planning counselors contact you for free information on our pre-planned funerals?                         


10 ___ Yes                  ___ No


If this survey has reached you at a time of illness or loss, please accept our apologies.