Funeral Home

FUNERAL HOME – FUNERAL/MEMORIAL REQUEST

** IMPORTANT PLEASE READ **
THIS FORM IS FOR FUNERAL HOME USE ONLY

Before you request us please ensure you have the following:

  • Family authorization. We must be invited by the family.
  • Family contact information including name and phone number.
  • Funeral director contact information including name and phone number.
  • Will the military (if applicable) be present

FUNERAL DIRECTOR – If you do not hear back from us within 48 hours please contact us at help@northtxpgr.org.

Please note – All fields marked with a * are required.

EFFECTIVE APRIL 10, 2023 – IN ORDER TO ALLOW AMPLE TIME TO PROCESS YOUR REQUEST FOR OUR PRESENCE, PLEASE ALLOW A MINIMUM OF 48 HOURS PRIOR TO YOUR DESIRED SCHEDULE DATE AND TIME. REQUEST FOR OUR PRESENCE ON A MONDAY MUST BE RECEIVED BY US NOT LATER THAN FRIDAY AT 12 NOON. REQUESTS AFTER THAT TIME CANNOT BE HONORED.

    Deceased Information

    Deceased Name *


    Status *

    Military Service or First Responder

    Service Information

    Deceased Photo Upload


    *The file size MUST be less than 2MB.

    Do you have a copy of the DD214?



    *The file size MUST be less than 2MB.

    FUNERAL DIRECTOR INFORMATION

    Requester's Name *


    Contact Number *

    Email Address *

    Date you are Requesting Our Presence*

    Service Start Time*

    :

    FUNERAL HOME INFORMATION

    Funeral Home Name

    Funeral Home Address




    Phone Number

    FAMILY INFORMATION

    If you are NOT an immediate family member, please enter the name of the person we should contact.

    Family Member Name *


    Family Member Contact Number *

    Family Member Email Address

    Relationship to Deceased *

    SERVICE INFORMATION

    Location Name

    Location Contact


    Contact Phone Number

    Location Address




    Casket / Urn*

    Service Details*

    Will the military be present? *

    Do you need pallbearers? *

    Does the PGR need to fold the flag? *

    Cemetery Name

    Cemetery Contact


    Contact Phone Number

    Cemetery Address