(800)750-4222 toll free

PRE-ARRANGEMENT FORM

Pre-arrangement can be as easy as filling out this form and submitting it, or printing a copy , completing , and mailing it to:

Proko-Wall Funeral Home
Attn: MarLynn
1630 E. Mason St.
Green Bay WI 54302

800.750.4222

Please complete to your level of comfort.

Name (First/Middle/Last):
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Email Address:
  
Birthdate:
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Spouse's Name (Maiden) :
  
Father's Name:
 Mother's Maiden Name:
Education Level Completed (1-17):
   
Occupation:
 Industry:
   
Military Service:  
Branch:
 War:
Enlisted:
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Religion:
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Cemetery:
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Address:
  
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Preferred Service Type:
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1630 E. Mason St. • Green Bay, WI 54302 • 920-468-4111 or 1-800-750-4222 © 2008 Proko-Wall Funeral Home and Crematory, Inc.