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Funeral Information Form

Funeral Information Formwadesolomon@key2tech.com2025-07-28T07:34:07+00:00

Name of the Deceased

ITSDA Member(Required)

Yes

No

Date of Death(Required)

Date of Birth(Required)

Date of Funeral(Required)

Time of Funeral(Required)

Hours

:

Minutes

AM/PM

Name of Funeral Home(Required)

Contact Person(Required)

Phone(Required)

Location of Interment(Required)

Family Contact Person(Required)

Family Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Select Applicable Items

Repast

Vegetarian meal only

Assistance needed with planning

Choir/Soloist requested

Musician requested

Pallbearers requested

Will a photo representation to be provided for the visitation

Obituary request to southern tidings

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CONTACT INFO

2102 S. Alston Ave, Durham, NC 27707

Phone: 919-973-1638

Email: info@immanueltemplechurch.com

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