Program Questionnaire

NOTE: Many of the fields on this form are required. The required fields are marked with an asterisk ( * ). If you are unsure of the answer to a required field, or if it's not applicable - please enter "N/A" into the field.

Please provide the name and contact information of the person responsible for making the arrangements of the deceased.

If photos are to be included in the program, please submit them in the field below. You can submit multiple photos.

In the field below, please provide the name of the Officiating Minister (the person Delivering the Eulogy).

In the field below, please provide the name of the Presiding Minister or Worship Leader (if any).

In the field below, please type or copy/paste the personalized obituary for the deceased. If you would like the funeral home staff to write a personalized obituary for your loved one, please list below some personal information; such as how the deceased would like to be remembered; how family would like to remember the deceased; personal characteristics; those things in life that were precious to your loved one, etc. The funeral home will use the information you submitted for the newspaper in addition to this information in writing the obituary.

If you already have the obituary on a separate document, instead of pasting that in the above field, you can use the field below to upload the obituary document.

If there are any poems or other special readings to be printed in the program, please submit them in the field below.

Please list the name of each Pallbearer you wish to have printed in the program. Usually there are six pallbearers.

If there are any Honorary Pallbearers you wish to have printed in the program, please list them below. Separate each name with a comma please.

The funeral home staff will carry flowers from the church at the end of the service, however, if you wish to designate floral bearers, please list their name(s) in the field below for printing in the program. If there are multiple names, please separate each with comma.

If you wish printed in your program where family and friends will be received after the funeral service (repast), please give the location name and physical address in the field below.

In the field below, please indicate other special items you wish printed in your funeral program, such as family acknowledgement (thank you from the family), etc. Wallace Funeral Directors will take care of writing a thank you note for you if you do not wish to do so.

Please provide us with your contact information in case we have any questions about what you've shared and requested.