Funeral Request Form
This form will be used to request officers for funeral escorts.
***Funeral request made within 24 hours of escort may not be covered***
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Email *
Funeral Home *
Select funeral home from list below. If not listed select Other: and fill in funeral home name
Point of contact *
First & Last Name
POC phone number *
Number of officers requested *
Deceased Name *
Date of escort *
MM
/
DD
/
YYYY
Type of escort *
One part - Only one way and 1 destination. Two part - Pick up and take to first destination then drop off at final destination.
Funeral service start time *
Time
:
Special considerations
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