Pre-Need Information Request
* designates a required field

General Information
* First Name:  
Middle Name:
* Last Name:  
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Cell Phone #:
* E-mail:    
I Would Like Information Regarding:



Cemetery (If Applicable)
Name:
Address:
City:
State:
Zip:
Phone #:
 
 
Place of Funeral Service


Church
Name:
Address:
City:
State:
Zip:
Phone #:
 
 
Other Location
Name:
Address:
City:
State:
Zip:
Phone #:
 
 
Visitation





Please provide us with any additional information below (500 characters)  

©2010 Miller Funeral and Cremation Services, Inc. | 3325 Winton Road South | Rochester, NY 14623 Phone: 585.424.3700 | Fax: 585.424.6952
Memorial Contributions  |  Contact Us  |  Site Map  |  Website Powered by ITX.com
New York State Funeral Directors AssociationRochester Genesee Valley Funeral Directors AssociationNational Funeral Directors Association