Pre-Arrangement Form

Your Information

Full Name*:

Legal First, Middle and Last Name

Name as it should appear on non-legal documents:

example: William goes by "Bill"

Mailing Information

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Email Address*:

Phone Number:

Date of Birth:

City of Birth:

State of Birth:

Spouse's Information

Spouse's Name:

Spouse's Maiden Name:

Spouse's Address

Address:

City:

Country:

State/Province:

Zip/Postal code:

Date of Marriage:

Place of Marriage:

Additional marriage information:

Father & Mother Information

Father's Name:

Father's City of Residence:

Mother's Name:

Mother's Maiden Name:

Mother's City of Residence:

Work & Education

Education:

Your Occupation:

Kind of Business:

Company Name:

Military Information

Branch Service:

Serial Number:

Date Enlisted:

Rank at Discharge:

Date Discharged:

Discharge on File at:

Copy of Discharge Papers:

Yes

Military Honors:

Yes

Funeral Service Information

Place of Service:

I Prefer the Funeral Service To Be:

Viewing for Family:

Yes

Viewing for Friends:

Yes

Religious Denomination:

Place of Worship:

Lodge or Union:

Disposition Information

I Prefer:

Cemetery:

Address:

Phone:

I Have Made A Last Will & Testament:

Yes

Additional Information

Flower Preference:

Music Selections:

Casket Pallbearers:

Jewelry:

Glasses:

Clothing:

Special Instructions

Other Information:

Memorials & Charities:

Send Information

Please select one of the options below*:

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2907 Mulberry Ave.
Muscatine, IA 52761

563-263-8112 phone
563-263-4001 fax
wittichlewis@machlink.com

603 Second Street
Columbus Junction, IA 52738

319-728-8151 phone
319-728-7534fax
stacylewisfh@windstream.net

100 DeVoe Street
P.O. Box 395
Lone Tree, IA 52755

319-629-5118 phone
319-629-4918 fax
lewisfuneral@iowatelecom.net

111 N. Greene Street
Riverside, IA 52327

319-648-4111 phone
319-629-4918 fax
lewisfuneral@iowatelecom.net

Pre-Arrange Online Now

Mailing Information

Spouse's Address

It's hard to forget someone;
Who gave you so much to remember.
-Author Unknown

Geo. M.
Wittich-Lewis

Stacy-Lewis
Columbus Junction

Sorden-Lewis
Lone Tree

Sorden-Lewis
Riverside

qUICK lINKS

Pre-Arrangement Form

Pre-Arrange Online Now

Mailing Information

Spouse's Address

It's hard to forget someone;Who gave you so much to remember.-Author Unknown

Geo. M.Wittich-Lewis

Stacy-LewisColumbus Junction

Sorden-LewisLone Tree

Sorden-LewisRiverside

qUICK lINKS

It's hard to forget someone;
Who gave you so much to remember.
-Author Unknown

Geo. M.
Wittich-Lewis

Stacy-Lewis
Columbus Junction

Sorden-Lewis
Lone Tree

Sorden-Lewis
Riverside